Sedentarization and children's health: Changing discourses in the northeast Badia of Jordan

The significance of the socioeconomic and cultural contexts of individuals' accounts of health and illness is recognized in studies of lay discourses of health and illness. However, many studies of health care utilization argue that social and cultural contexts in non-industrialized countries reinforce the use of traditional medicines and constitute barriers to the effective use of biomedical services, reflecting the rooting of such studies in discourses of modernization and development. Based on interviews with 181 parents, this article illustrates the influence of development on changing discourses of children's health and illness among sedentarizing Bedu communities of the northeast Badia of Jordan. The accounts of sedentarized and semi-nomadic families are contrasted. It is suggested that Bedu social values have precipitated rather than inhibited changes. The article highlights the importance of understanding historical, socioeconomic and cultural contexts in formulating appropriate models of health service delivery.

Preadoption opportunities for pediatric providers

International adoption pairs the most vulnerable and high-risk pediatric population with the lowest risk parent group. International adoption also presents unique and rewarding challenges for primary care pediatricians. After receiving information from the medical reviewer, a parent must determine whether or not this child is "their child." The position of the medical reviewer is to provide the family with as much information as possible about the health status of the child by explaining the terminology in the report and assessing the photograph or videotape. It is also the reviewer's job to guide the parent's expectations of the adoption by explaining the inherent differences in the development of children in institutions. In the preadoption phase, we must remember that our ultimate goal is to aid in the permanent placement of a child with a family that has realistic expectations and is well prepared to aid that child to reach his or her fullest potential.

Attenuation of Racial Differences in Health Service Utilization Patterns for Previously Uninsured Children in the Delta

CONTEXT

A school-based health insurance program for children of the working poor was conducted in 2 isolated, rural communities in the Lower Mississippi Delta region. The larger of the 2 communities had an array of locally available health care providers, whereas the smaller community did not. In response to this lack of available care, the project designed and delivered outreach programs, including transportation to providers.

PURPOSE

The purpose of this paper is to examine the role of race, age, and gender in the relationships between the utilization of care and the impact of outreach programs.

METHOD

General estimating equation models are used to examine the response of utilization variables to race, age, gender, and community. Four years of insurance claims data are analyzed.

FINDINGS

Race is seen to be an important component of utilization. The majority of participants were African American; however, children receiving prescription services, emergency room care, routine physician visits, and hospital outpatient services were more likely to be white. Outreach programs in vision and dental services were found to eliminate racial differences and increase utilization. A relatively strong gender effect was found in prescription, wellness, vision, and dental services.

CONCLUSIONS

Previous research has shown differences by race in utilization of care. Our findings show that targeted outreach programs can significantly diminish these differences. Findings also suggest that barriers to health care for poor rural children are closely linked to transportation and availability of providers, not merely to cost of care or insurance.

Cultural competence in the assessment of poor Mexican families in the rural southeastern United States

Increasing numbers of poor Mexican immigrant families are settling in the rural southeastern United States. Most of these families are from isolated agrarian communities in Mexico and are headed by unskilled laborers or displaced farm workers with little education. Child welfare workers and other service providers in rural communities may be poorly prepared to address the needs of this population. This article provides an overview of the cultural, social, and family dynamics of first generation, working class Mexicans to promote cultural competency among helping professionals. An ecological perspective is used to examine the strengths that poor Mexicans bring from their culture of origin, stresses of the migratory experience and ongoing adaptation, shifts that may occur in family structure and functioning, disruptions in the family life cycle, the role of social supports in family adaptation, and effect of institutional discrimination on family well-being. Suggestions also are made for essential components of adequate in-service education.

Ethnic differences in quality of life in adolescents among Chinese, Malay and Indians in Singapore

BACKGROUND

Health-related quality of life in adolescents and ethnic and cultural differences are not well characterized. We used the Quality of Life Questionnaire for Adolescents (QOLQA) to examine ethnic differences in reported QOL scores among Chinese, Malay and Indian ethnicities in Singapore.

METHODS

The 70-item QOLQA measuring five QOL domains (physical, psychological, independence, social and environmental) was administered to a random sample of 1363 school-children aged 10-15 years, representative of the ethnic composition of Singapore adolescents (Chinese 72%, Malays 20% and Indians 8%).

RESULTS

Indians reported the highest overall QOL (mean 3.71 +/- SD 0.54) compared to Chinese (3.59 +/- 0.43), p < 0.05, and Malays (3.58 +/- 0.44), p < 0.05. In particular, Indians had significantly higher psychological QOL scores (3.73 +/- 0.61) compared to Chinese (3.55 +/- 0.54), p < 0.01. On the other hand, Chinese scored highest on physical and independence domains (3.97 +/- 0.54), p < 0.01 compared to Malays (3.82 +/- 0.55). There were no statistically significant gender differences in QOL scores. QOL declined significantly from age 10 to 15 for overall score, psychological, physical (p < 0.01) and environmental (p < 0.05). Lower socio-economic status and the self-report of a significant health problem were significantly associated with lower overall QOL and most domains. These ethnic differences persisted after adjusting for differences in socio-economic and health status. Psychometric properties and known group construct validity appeared to be similar across different ethnic groups, but compared to Chinese (r = 0.39) or Malays (r = 0.39), Indians showed a higher correlation of psychological scores with physical score (r = 0.59) and with other domain scores.

CONCLUSION

Significant ethnic differences in reported adolescent quality of life among Chinese, Malays and Indians in Singapore that are independent of socioeconomic and health status suggest important cultural differences.

Sudanese refugee youth in foster care: the "lost boys" in America

This study examined the resettlement experiences of unaccompanied Sudanese refugee youth placed in foster care from the perspectives of the youth, foster parents, and agency caseworkers. Youth experienced considerable success. The challenges of adjusting to school and family life, however, suggest a need for funding to support more intensive educational services, more cultural training and support for foster parents and school personnel, and flexibility to provide services in more culturally appropriate modalities.

In the "best interest" of immigrant and refugee children: deliberating on their unique circumstances

Each year, state juvenile courts provide thousands of immigrant and refugee children with access to consistent and reliable caregiving and a stable environment. To examine how courts interpret "the best interests" of immigrant and refugee children, this article examines 24 cases in courts across the United States, which indicate they use a territorial approach when evaluating the best interests standard. Although legal status was not an issue, many related factors were. Consequently, the courts restricted immigrant parents' rights in caring, guiding, and visiting their children; increased the risk of wrongfully terminating parental rights; and intensified the unpredictability of immigrant and refugee children's welfare in the long run. This article suggests an approach that encourages communication between social workers and the courts to address the special needs and circumstances of immigrant and refugee children on three key topics: the material and moral welfare of the child, and social welfare for immigrant and refugee families.

Serving immigrant families and children in New York City's child welfare system

This article describes the efforts and special initiatives of New York City's Administration for Children's Services to improve services to immigrant and English language learner populations. Children's Services convened an immigration issues advisory subcommittee, created special tools for child welfare staff, collaborated with legal agencies to assist foster children with immigration status adjustments, improved agency data collection, and launched an agency-wide training initiative on immigration issues. The challenges encountered by Children's Services offer important insight for child welfare agencies in other jurisdictions designing strategies to strengthen their services for immigrant communities.

The Call-Centre: a child welfare liaison program with immigrant serving agencies

Alberta, Canada, welcomed nearly 16,000 landed immigrants in 2003, of whom more than half came to the Calgary area. Approximately 200,000 immigrants of various ethnic and cultural groups now live in the region. Many of these new arrivals have no natural support networks while struggling with language, cultural, and economic barriers. Recognizing these difficulties, the Calgary and Area Child and Family Services Authority (CFSA) joined with several Immigrant Serving Agencies to develop guidelines and procedures to direct staff working with diverse cultures, including the Call-Centre pilot project, which provided CFSA staff with a one-stop telephone contact for information about an immigrant or refugee family, their culture, and available culturally-appropriate resources. The Call-Centre, which is currently being evaluated by researchers at the University of Calgary, will gradually expand to all CFSA sites in the region. This article describes the Call-Centre and the first phase of the evaluation.

Protective Influences of Families for Children Adopted From the Former Soviet Union

PURPOSE

To (a) characterize the total competence of 9- to 12-year old children adopted from the former Soviet Union who have resided in the United States at least 5 years, and (b) evaluate risks and protective influences of adoptive families and their relationships to competence.

DESIGN

Longitudinal, descriptive study.

METHODS

In the previously reported phase, the families of 105 internationally adopted children and their families from 23 U.S. states were assessed via telephone interviews and postal survey. In this phase, 3.5 years later, 46 of the families from 16 states were located and reassessed. Measures included: Total Competence scale of the Child Behavior Checklist (CBCL), Family Environment Scale (FES), and demographic information. Multivariate regression analysis was conducted to determine which risk and protective factors contributed to competence scores of the adopted children.

FINDINGS

Between Time 1 (mean age of children, 7.7 years) and Time 2 (mean age of children, 11 years), average scores on the Total Competence scale of the CBCL did not change significantly, despite impending challenges of early adolescence. Subdomain scores on the FES were more positive than norms. Results from the regression analysis showed that, of the risk and protective factors considered, only birth weight and the cohesion subscale of the FES were statistically significant in explaining variation in the competence score of the CBCL.

CONCLUSIONS

Families continued to face challenges, but findings were consistent with other studies showing that, despite early adversities, these adopted children generally fared well developmentally with protective family environments of major importance.

Effective child welfare practice with immigrant and refugee children and their families

This article presents a multistage migration framework to broaden the lens through which child welfare personnel can view immigrant and refugee families and their children. By better understanding the family's experiences in both emigration and immigration, including reasons for leaving their home country, experiences in transit, and reception and resettlement experiences in the United States, child welfare personnel are better equipped to assess their needs and provide effective prevention, protection, permanency, and family preservation services. Case examples illustrating the application of the framework and guidelines for program and practice are included.

Bridging refugee youth and children's services: a case study of cross-service training

Bridging Refugee Youth and Children's Services(BRYCS), a public-private partnership between the federal Office of Refugee Resettlement, Lutheran Immigration and Refugee Service, and the United States Conference of Catholic Bishops, provides national technical assistance to public child welfare. After a series of "community conversations," BRYCS identified a lack of knowledge among child welfare staff about newcomer refugees, negative stereotypes, and a fear of child protective services among refugees. BRYCS initiated a number of technical assistance initiatives, including a pilot cross-service training project in St. Louis to strengthen collaboration between child welfare and refugee-serving agencies. This article details the lessons learned from this training and recommends changes in policy and practice.

An educational model for child welfare practice with English-speaking Caribbean families

Implemented in New York City, the Child Welfare Fellowship Project is an international collaboration between social work educators in the United States and Jamaica, the West Indies, the public child welfare agency, and selected community-based agencies. This model educational program prepared selected Masters of Social Work (MSW) Fellowship students for exemplary child welfare practice with English-speaking Caribbean families by providing enhanced programs designed to support culturally competent skill development and a preventive approach to child welfare practice. These educational enhancements, combined with academic course work, increased professionalism, self-efficacy, and culturally competent skill development among participants and averted foster care placement for families seen over the duration of the project.

[Surname as a marker of ethnicity. A study from child health services shows that immigrant respective Swedish families seem to be isolated in different ways]

A practical method was tested for identifying ethnicity through family names in the absence of precise demographic information. In a questionnaire study of children covered by the Swedish child health services in some different counties, all potential participants (the children's mothers) were classified as "Swedish" or "non-Swedish" using family names. Inter-rater reliability was assessed by comparing the scores of two independent raters (Cohen's kappa: 0.89). Cases in which the raters did not agree were settled through discussion. The method's validity was roughly measured by comparing assigned classifications against ethnicity information provided by the 63.8 percent of the mothers who returned the questionnaire (1039 of 1628). Assigned and self-reported classifications were the same in 86.5 percent of the cases. Information from child health services about mothers who had agreed to participate in the study revealed health-related differences between those who returned the questionnaires and those who did not. The family name classification method indicated an ethnic selectivity in drop-out rates, which was helpful in interpreting these health differences.

Rethinking race/ethnicity, income, and childhood asthma: racial/ethnic disparities concentrated among the very poor

OBJECTIVE

Past studies of the prevalence of childhood asthma have yielded conflicting findings as to whether racial/ethnic disparities remain after other factors, such as income, are taken into account. The objective of this study was to examine the association of race/ethnicity and family income with the prevalence of childhood asthma and to assess whether racial/ethnic disparities vary by income strata.

METHODS

Cross-sectional data on 14,244 children aged <18 years old in the 1997 National Health Interview Survey were examined. The authors used logistic regression to analyze the independent and joint effects of race/ethnicity and income-to-federal poverty level (FPL) ratio, adjusting for demographic covariates. The main outcome measure was parental report of the child having ever been diagnosed with asthma.

RESULTS

Bivariate analyses, based on weighted percentages, revealed that asthma was more prevalent among non-Hispanic black children (13.6%) than among non-Hispanic white children (11.2%; p<0.01), but the prevalence of asthma did not differ significantly between Hispanic children (10.1%) and non-Hispanic white children (11.2%; p=0.13). Overall, non-Hispanic black children were at higher risk for asthma than non-Hispanic white children (adjusted odds ratio [OR]=1.20; 95% confidence interval [CI] 1.03, 1.40), after adjustment for sociodemographic variables, including the ratio of annual family income to the FPL. Asthma prevalence did not differ between Hispanic children and non-Hispanic white children in adjusted analyses (adjusted OR=0.85; 95% CI 0.71, 1.02). Analyses stratified by income revealed that only among children from families with incomes less than half the FPL did non-Hispanic black children have a higher risk of asthma than non-Hispanic white children (adjusted OR=1.99; 95% CI 1.09, 3.64). No black vs. white differences existed at other income levels. Subsequent analyses of these very poor children that took into account additional potentially explanatory variables did not attenuate the higher asthma risk for very poor non-Hispanic black children relative to very poor non-Hispanic white children.

CONCLUSIONS

Non-Hispanic black children were at substantially higher risk of asthma than non-Hispanic white children only among the very poor. The concentration of racial/ethnic differences only among the very poor suggests that patterns of social and environmental exposures must overshadow any hypothetical genetic risk.

Transformation for health: A framework for health disparities research

The task of generating knowledge addressing disparities in health among vulnerable populations in American society is explored. The community-based participatory approach as an alternate paradigm to traditional research is mentioned as a process for understanding the realities of the populations of interest. Identification and testing of mediating and moderating variables is suggested to guide the process of increasing knowledge regarding health disparities. Transformation for Health is proposed as a conceptual framework to study how these third variables influence the relationship between the primary variables of interest. A theoretical example is offered describing the application of the framework to study the mediators and moderators in an investigation of childhood obesity. Analytical challenges in the exploration of "third variables" are described, and the authors recommend that salient methodological issues should be addressed when conducting these types of investigations.

Are there universal parenting concepts among culturally diverse families in an inner-city pediatric clinic?

INTRODUCTION

Cultural competence is necessary in providing care to culturally diverse families. Numerous studies have emphasized similarities and differences between predetermined cultural groups, yet few have studied groups across cultures. This project aimed to investigate parenting concepts, which in this context pertains to philosophy of parenting and child care practices across cultures.

METHOD

Using a grounded theory approach, ethnographic interviews of 46 families representing 27 countries were taped, transcribed, and analyzed.

RESULTS

Similarities in parenting concepts were found among families. Teaching values and respect and the need for strict discipline were important. A sense of community, family, and spirituality/religion was strong. Television was viewed as educational and parents anticipated opportunities for jobs and higher education for their children. Parents were more inclined to use medical treatments than home remedies for acute illnesses, which may have been linked to the finding that their providers had a strong influence. Parents feared children playing alone outdoors; distrusted nonfamily babysitters; and felt conflicted between a desire for cultural preservation versus assimilation.

DISCUSSION

Universal concepts in parenting philosophies and practices exist among culturally diverse families. Providers may approach anticipatory guidance by addressing global parental concerns that transcend culture in order to relieve time constraints and the overwhelming task of being knowledgeable about all cultures.

A decomposition of trends in poverty among children of immigrants

Poverty levels among all children in the United States have tended to fluctuate in the past 30 years. However, among the children of immigrants, child poverty increased steadily and rapidly from about 12% in 1970 to 33% in the late 1990s before declining to about 21% in 2000. Using 1970, 1980, 1990, and 2000 Public Use Microdata Samples data, we identified key factors that underlie the fluctuations in immigrant child poverty from 1969 to 1999 and the divergence from children of natives. We found that roughly half the absolute increase in immigrant child poverty can be linked to changing conditions in the U.S. economy that make it more difficult to lift a family out of poverty than 30 years ago. These changes occurred disproportionately among children of parents with lower levels of education, employment, and U.S. experience but not among racial/ethnic minorities. Poverty risks among various racial and ethnic groups converged over time. The relative increase in poverty for immigrant versus native children owes largely to the divergence between immigrant and native families in racial/ethnic composition, parental education, and employment.

Family structure and children's educational outcomes: blended families, stylized facts, and descriptive regressions

This article adds to the growing literature describing correlations between children's educational outcomes and family structure. Popular discussions have focused on the distinction between two-parent families and single-parent families. This article shows that educational outcomes for both types of children in blended families--stepchildren and their half-siblings who are the joint children of both parents--are similar to each other and substantially worse than outcomes for children reared in traditional nuclear families. We conclude that as a description of the data, the crucial distinction is between children reared in traditional nuclear families (i.e., families in which all children are the joint children of both parents) and children reared in other family structures (e.g., single-parent families or blended families). We then turn from "stylized facts" (i.e., simple correlations) that control only for family structure to "descriptive regressions" that control for other variables such as family income. When controls for other variables are introduced, the relationship between family structure and children's educational outcomes weakens substantially and is often statistically insignificant.

Factors associated with obesity in Chinese-American children

OBJECTIVE

A cross-sectional study design was utilized to examine factors associated with obesity in Chinese-American children.

SUBJECTS

Chinese-American children (8 to 10 years old) and their mothers (N = 68) in California participated in the study.

MEASUREMENTS

Mothers completed demographic information, the Family Assessment Device, Attitudes Toward Child Rearing Scale, and Suinn-Lew Asian Self-identity Acculturation Scale. Children's body mass index was measured, and children completed a self-administered physical activity checklist, Food Frequency Questionnaire, and the Schoolagers' Coping Strategies Inventory.

RESULTS

Results indicated three variables that predicted children's body mass index: older age, a more democratic parenting style, and poor communication (R2=.263, F=8.727, p = .0001). Children whose mothers had a low level of acculturation were also more likely to be overweight than were children whose mothers were highly acculturated.

CONCLUSION

This study revealed that children's ages, a democratic parenting style, and poor family communication contribute to increased body mass index in Chinese-American children. Other factors related to children's BMI and dietary intake include acculturation level of the mother and family affective responses. Future studies should examine the change in BMI over time and in different age groups and why parenting and family communication impact children's body weight.

Pavlov's influence on American psychology: completing the puzzle

In this paper, a historical approach to the influence of Pavlov on American psychology is presented. After consider what we call the "received view": Pavlov's influence on American psychology is seen mainly, perhaps solely, as related to behaviorism, we present an alternative view in which the influence of the Russian is interpreted in relation to Florence Edna Mateer (1887-1961), William Horsley Gantt (1892-1980) and Howard Scott Liddell (1895-1962).

Measuring health status and quality of life for US children: relationship to race, ethnicity, and income status

OBJECTIVE

Accurately measuring the health of the increasingly diverse population of US children requires instruments that are comparable and valid across cultures, economic background, and language. This paper asks: Has the field of pediatric health status measures reached this level of comprehensiveness?

METHODS

Children's health status and quality of life measures commonly used in the United States were reviewed to assess how they have included racial/ethnic minority and low-income groups. Four generic and 2 condition-specific instruments (asthma) were examined for total sample size, percent of sample from racial/ethnic and low-income groups, language availability, translation methods for US-Spanish, reading level, and separately reported psychometric findings and outcomes/scores.

RESULTS

Most measures have included minority groups, usually African American or Hispanic children, although with little information by Hispanic subgroup. Children's measures have generally been tested on relatively small samples, without separate analyses by subgroups. When done, tests of reliability and validity find few differences from the general population. Some studies report information on health by racial or ethnic group, but the findings are inconclusive. Economic status is usually measured in some way, but rarely are psychometric findings examined separately by income. When differences in health outcome are reported by income, lower income children usually have poorer health.

CONCLUSIONS

Much has been accomplished in advancing health status measures for children. Next-generation issues include the influence of race, ethnicity, and income on health and health reports.

International child health

It is our hope that this issue of Pediatric Annals will stimulate among readers a desire to learn more about the difficult challenges faced by our colleagues who live and work in developing countries. They do so much with so little, and their dedication to their work is an inspiration to us all. Armed with such information, working as individuals and as members of political, educational, charitable, and service organizations, we can help many of the children who otherwise will be lost without our attention.