American children at risk: Poverty and its consequences for children's health, growth, and school achievement

The Social Determinants of Health and Athletic Trainer Availability in Indiana Secondary Schools

CONTEXT

The social determinants of health (SDOH) are circumstances under which individuals are born, work, and live that influence health outcomes. Previous researchers have examined 1 determinant of economic stability and found disparities in socioeconomic status and athletic trainer (AT) availability.

OBJECTIVE

To examine the SDOH characteristics of Indiana secondary schools and AT availability.

DESIGN

Cross-sectional study.

SETTING

Database secondary analysis.

PATIENTS OR OTHER PARTICIPANTS

A total of 426 secondary schools.

MAIN OUTCOME MEASURE(S)

All data were collected from publicly available databases. The independent variable was AT availability, and schools were classified as having a full-time AT, a part-time AT only, or no AT. The SDOH variables were gathered for each school (at the school and county levels). Data were summarized using measures of central tendencies, 1-way analysis of variance, and Kruskal-Wallis tests.

RESULTS

School enrollment was larger in schools with greater AT availability (P< .001). The proportion of non-White students was greater in schools with more AT availability (P= .002). Greater AT availability was present in counties with higher graduation rates (P= .03). Post hoc comparisons revealed differences in graduation rates between schools with a part-time AT and those with no AT (P= .04). Schools with less AT availability were located in counties with a slightly higher percentage of the population uninsured (P= .02). Schools with greater AT availability were located in counties with a higher ratio of population to primary care physicians (P= .03). Schools with less AT availability were located in counties with a higher population experiencing severe housing problems (P= .02). No differences were found in AT availability based on the 3 social and community context variables (P> .05).

CONCLUSIONS

Differences were noted in AT availability and SDOH characteristics at the secondary school level. We observed less AT availability where high school graduation rates and the population of primary care providers were lower. Strategies should be implemented to improve access to athletic health care in underresourced communities.

Early Childhood Education Teacher Workforce: Stress in Relation to Identity and Choices

The early childhood education teacher workforce is consistently relied upon to bolster children's academic and socioemotional development in preparation for kindergarten and long-term outcomes. This is especially true of children who, historically overlooked and marginalized, are labeled "at risk." While research has focused on pervasive stressors as obstacles to these classroom professionals (e.g., teacher/teaching stress, curricular mandates, quality assessments, COVID-19), there is less research on stress in relation to the formation of teacher identity; specifically, how stress contributes to and detracts from the formation of a teacher's micro-identity, and how negative impacts of stress to the micro-identity may contribute to teachers' decisions to leave the field. Although once considered to be one of the fastest growing industries, The Great Resignation, as it has come to be known, estimates up to 25-30% of the workforce leave annually. To better understand the choices teachers make to leave the profession, the current study examined the influence of stress on teachers' microidentity by centering the voices of six Head Start teachers. Implementing a qualitative design, this investigation asked (a) Who are the Head Start teachers in the workforce today? (b) What are the particular stressors with which they contend? (c) How does the micro-identity of these teachers change as a result of stress, and what are the potential choices that follow? Results and findings indicated that Head Start teachers experience (1) stress as reality, (2) stress-shaped identities, and (3) identity-mediated choice. Implications and insights are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10643-023-01468-w.

Exposure to a mixture of metals and growth indicators in 6-11-year-old children from the 2013-16 NHANES

Lead (Pb), mercury (Hg) and fluoride (F) exposure during childhood is of concern owing to their toxicity. Also, evidence suggests that high and low exposure levels to manganese (Mn) and selenium (Se) during this vulnerable period are associated with an increased risk of adverse health effects. A reduced growth is associated with high Pb and F exposure; however, little is known about their impact on children's body size, and there is a lack of consensus on the effects of Hg, Mn, and Se exposure on children's anthropometric measures. This is particularly true for childhood metal co-exposures at levels relevant to the general population. We investigated the joint effects of exposure to a metal mixture (Pb, Mn, Hg, and Se in blood and F in plasma) on 6-11-year-old US children's anthropometry (n = 1,634). Median F, Pb, Mn, Hg, and Se concentrations were 0.3 μmol/L, 0.5 μg/dL, 10.2 μg/L, 0.3 μg/L, and 178.0 μg/L, respectively. The joint effects of the five metals were modeled using Bayesian kernel machine and linear regressions. Pb and Mn showed opposite directions of associations with all outcome measured, where Pb was inversely associated with anthropometry. For body mass index and waist circumference, the effect estimates for Pb and Mn appeared stronger at high and low concentrations of the other metals of the mixture, respectively. Our findings suggest that metal co-exposures may influence children's body mass and linear growth indicators, and that such relations may differ by the exposure levels of the components of the metal mixture.

Elevated Blood Lead Levels Among Resettled Refugee Children in Ohio, 2009-2016

Objectives. To assess the prevalence of and the demographic factors for elevated blood lead level (EBLL; ≥ 5 µg/dL) at resettlement among newly admitted refugee children. Methods. This cross-sectional study used data from the postresettlement refugee medical screening of 5661 children resettled in Ohio from 2009 to 2016. We computed prevalence of EBLL and adjusted prevalence ratio with modified Poisson regression modeling. Results. Overall, 22.3% of children younger than 18 years and 27.1% of those younger than 6 years had an EBLL. Children resettled from a South Asia region including Afghanistan (EBLL prevalence = 56.2%; 95% confidence interval [95% CI] = 48.1%, 64.3%), Nepal (44.0%; 95% CI = 33.7%, 54.1%), Bhutan (32.8%; 95% CI = 30.4%, 35.9%), and Burma (31.8%; 95% CI = 27.5%, 35.9%) had the highest prevalence of EBLLs. In addition, those younger than 6 years (prevalence ratio [PR] = 2.0; 95% CI = 1.6, 2.6), male (PR = 1.3; 95% CI = 1.1, 1.4), and screened within 30 days of arrival (PR = 1.7; 95% CI = 1.1, 2.5) had significantly higher EBLL prevalence than did children aged 13 years and older, female, and screened 90 days after arrival. Conclusions. The overall high proportion of EBLL and variation in EBLL by country of origin among resettled refugee children in the United States warrant comprehensive, yet tailored, guidelines for health professionals and resettlement and government agencies for better prevention and awareness programs targeting these high-risk children.

Stress, migration, and allostatic load: a model based on Mexican migrants in Columbus, Ohio

Background

Immigration is a disruptive event with multiple implications for health. Stressors, including family separation, acculturation, job insecurity, restricted mobility, sojourns, dangerous border crossings, stigmatization, and marginalization, shape immigrant health in ways we are only beginning to untangle. Around the world, there are over 200 million international migrants. In 2015, there were 43.2 million immigrants living in the US, 26.8% of whom were born in Mexico. Investigating how stress affects health among migrants facilitates better understanding of their experiences.

Methods

Here, we review existing research on stress and how allostatic load varies among migrants with specific attention to Mexican migrants in the US. Next, we explore research incorporating biomarkers of allostasis and narratives of migration and settlement to examine disease risks of Mexican migrants residing in Columbus, Ohio. This mixed-methods approach allowed us to examine how social stressors may influence self-reports of health differentially from associations with assessed discrimination and physiological biomarkers of health.

Results

These data sources are not significantly associated. Neither narratives nor self-reports of health provide significant proxies for participants’ physiological health.

Conclusions

We propose, the pairing of objectively assessed health profiles with narratives of migration better illustrate risks migrants face, while allowing us to discern pathways through which future health challenges may arise. Immigration and acculturation to a new nation are biologically and culturally embedded processes, as are stress and allostatic responses. To understand how the former covary with the latter requires a mixed-methods bioethnographic approach. Differences across multiple social and physiological systems, affect individual health over time. We propose incorporating physiological biomarkers and allostatic load with migrants’ narratives of their migration to unravel complex relationships between acculturation and health.

Maternal phenotype, independent of family economic capital, predicts educational attainment in lowland nepalese children

OBJECTIVES

Factors acting before children are born or reach school-going age may explain why some do not complete primary education. Many relevant factors relate to maternal phenotype, but few studies have tested for independent associations of maternal factors relative to those characterizing the family in general.

METHODS

Using data from a longitudinal study of 838 children in Dhanusha, Nepal, we used logistic regression models to test whether indices of maternal somatic and educational capital, or family economic capital, were independently associated with children having had ≤2 versus 3+ years of schooling at a mean age of 8.5 years. We also tested whether maternal age, children's early growth, and urban/rural location mediated such associations.

RESULTS

Children had a higher risk of completing less schooling if their mothers were short, thin, anemic, and uneducated. Independently, lower family material assets and land acreage also increased children's odds of less schooling. There was an indication of gender differences, with the risk of poor educational attainment in girls associated with low maternal somatic and educational capital, whereas in boys the relevant factors were low maternal education and family land ownership.

CONCLUSIONS

Our analysis demonstrates that, independent of broader indices of family capital such as land or material assets, children's educational attainment is associated with factors embodied in maternal phenotype. Both somatic and educational maternal capital appeared important. A composite index of maternal capital could provide a new measurable proxy, prior to school entry, for identifying children at risk of completing fewer years of schooling. Am. J. Hum. Biol. 28:687-698, 2016. © 2016 Wiley Periodicals, Inc.

Associations of gender inequality with child malnutrition and mortality across 96 countries

National efforts to reduce low birth weight (LBW) and child malnutrition and mortality prioritise economic growth. However, this may be ineffective, while rising gross domestic product (GDP) also imposes health costs, such as obesity and non-communicable disease. There is a need to identify other potential routes for improving child health. We investigated associations of the Gender Inequality Index (GII), a national marker of women's disadvantages in reproductive health, empowerment and labour market participation, with the prevalence of LBW, child malnutrition (stunting and wasting) and mortality under 5 years in 96 countries, adjusting for national GDP. The GII displaced GDP as a predictor of LBW, explaining 36% of the variance. Independent of GDP, the GII explained 10% of the variance in wasting and stunting and 41% of the variance in child mortality. Simulations indicated that reducing GII could lead to major reductions in LBW, child malnutrition and mortality in low- and middle-income countries. Independent of national wealth, reducing women's disempowerment relative to men may reduce LBW and promote child nutritional status and survival. Longitudinal studies are now needed to evaluate the impact of efforts to reduce societal gender inequality.

Healthy Habits for Children: Leveraging Existing Evidence to Demonstrate Value

Healthy habits is a psychoeducational construct that refers to the preventive practice of analyzing and then adapting the sleep, physical, and eating routines of children in ways that enhance health and well-being. This approach is based on evidence that demonstrates the positive therapeutic value of engaging in proactive, healthful behaviors. In addressing healthy habits, occupational therapy practitioners have an opportunity to contribute to the Triple Aim of health care reform while demonstrating the value of occupational therapy in educational, medical, community, and other settings.

Translating human biology (introduction to special issue)

OBJECTIVES

Introducing a special issue on "Translating Human Biology," we pose two basic questions: Is human biology addressing the most critical challenges facing our species? How can the processes of translating our science be improved and innovated?

METHODS

We analyze articles published in American Journal of Human Biology from 2004-2013, and find there is very little human biological consideration of issues related to most of the core human challenges such as water, energy, environmental degradation, or conflict. There is some focus on disease, and considerable focus on food/nutrition. We then introduce this special volume with reference to the following articles that provide exemplars for the process of how translation and concern for broader context and impacts can be integrated into research.

CONCLUSIONS

Human biology has significant unmet potential to engage more fully in translation for the public good, through consideration of the topics we focus on, the processes of doing our science, and the way we present our domain expertise.

Partnering with students to explore the health needs of an ethnically diverse, low-resource school: an innovative large group assessment approach

School-based health programs have a unique and powerful potential to meet the health needs of children because students spend more time in schools than in any other environment away from home. We conducted a participatory needs assessment called a Group Level Assessment (GLA) in collaboration with an economically disadvantaged and ethnically diverse school to facilitate the students' identification of and subsequent action toward important health needs. A total of 68 students in Kindergarten through eighth grade participated in the GLA. Four major themes emerged: the desire for more sports and after-school activities, better school lunches, enjoyment of friends and families, and overall happiness. Other health issues identified by the students included limited health/medical care, stress resulting from schoolwork and grades, positive self-image, and the desire for more art opportunities. The salient themes identified by students are consistent with many factors identified in the academic literature as important in child socioemotional functioning.

School-based screening of the dietary intakes of third graders in rural Appalachian Ohio

BACKGROUND

Children in Appalachia are experiencing high levels of obesity, in large measure because of inferior diets. This study screened the dietary intake of third graders residing in 3 rural Appalachian counties in Ohio and determined whether the Food, Math, and Science Teaching Enhancement Resource Initiative (FoodMASTER) curriculum improved their dietary intake.

METHODS

Dietary intake was measured for 238 third graders at the beginning of the 2007 to 2008 school year and for 224 third graders at the end of that year. The FoodMASTER curriculum was delivered to 204 students (test group). Intake was measured using the Block Food Frequency Questionnaire 2004. The final analysis included 138 students.

RESULTS

The FoodMASTER curriculum did not significantly affect the diets of the students in the test group, as no significant differences in intake of macronutrients, specific nutrients, or food groups were found between the test and control groups. Majorities of students did not meet the Recommended Dietary Allowance or Adequate Intakes for fiber, calcium, iron, vitamin A, and vitamin E. The students as a whole did not meet the MyPyramid recommendations for any food group, and nearly one fifth of their calories came from sweets. Significant differences in percentages of kilocalories from protein and sweets and in servings of fats, oils, and sweets were seen between groups of higher and lower socioeconomic status.

CONCLUSIONS

Energy-dense foods are replacing healthy foods in the diets of Ohio children living in rural Appalachia. The prevalence of poor dietary intake in Appalachia warrants further nutrition interventions involving programming for nutrition, such as future FoodMASTER curricula.

Duration of poverty and child health in the Quebec Longitudinal Study of Child Development: longitudinal analysis of a birth cohort

OBJECTIVES

The objective of this study was to examine the relationship between duration of poverty and the health of preschool children in the Quebec Longitudinal Study of Child Development birth cohort.

METHODS

Data from the Quebec Longitudinal Study of Child Development for 1950 children who were followed annually up to age 3 years were analyzed. Poverty was defined as having an income below the low-income cutoff from Statistics Canada. Five health indicators were examined: asthma attacks, infections, growth delay, a cumulative health-problems index, and maternal perception of the child's health. The association between duration of poverty and child health was explored with logistic regression modeling controlling for child and mother characteristics, including the mother's level of education, social support, and physical violence.

RESULTS

In this birth cohort, 13.7% (268) 3-year-old children from the Quebec Longitudinal Study of Child Development experienced intermittent poverty since birth (1-2 episodes), and another 14.4% (280) experienced chronic poverty (3-4 episodes). Children from families with chronic poverty had more frequent asthma attacks and had a higher cumulative health-problems index score, whereas children with intermittent poverty were more often perceived to be in less than very good health by their mothers. These associations remained statistically significant when controlling for child and mother characteristics. No association was observed between duration of poverty and infections or growth delay.

CONCLUSIONS

Chronic poverty affects a large number of children and has negative consequences for preschool children's health, although universal health care is available. The effects of chronic poverty may vary according to different health indicators and the age of the child.

At-Risk High School Students in the “Gaining Early Awareness and Readiness” Program (GEAR UP): Academic and Behavioral Outcomes

The purpose of this study was to assess the effects of a GEAR UP intervention with at-risk high school students at a large urban high school in Florida. The goals of the GEAR UP program were to improve academic performance, decrease behavior-related problems, and reduce truancy and absenteeism. The study design consisted of a three-group comparison of the 447 students in GEAR UP: the No Participation Group, the Low Participation Group, and the High Participation Group. Participation levels were calculated for each category of activity (academic, behavior-related, and social), and propensity scoring was used to match the groups on sociodemographic characteristics and other differentiating variables. Results indicated that race (i.e., African American) and sex (i.e., female) are associated with high participation in program activities. Also, students who spent a substantial amount of time on academic activities improved their GPAs over a semester, and students who took advantage of behavior-related services and participated in social activities significantly reduced disciplinary referrals (p < .05). Suggestions for program refinement resulting from the study are discussed.

Reconstructing relationships among mortality, status, and gender at the Medieval Gilbertine Priory of St. Andrew, Fishergate, York

The varied relationships among status, gender, and mortality are complex, historically produced phenomena that shape people's lives and deaths in socially meaningful ways. Paleodemographic analysis coupled with acute sensitivity to site-specific context has the potential to move us toward a greater understanding of these experiences in the past. After considering the potential effects of migration and fertility on the age-at-death profiles of adult individuals interred at the Gilbertine Priory of St. Andrew, Fishergate, York (n = 200), it is asserted that these profiles primarily reveal expected and unexpected relationships among status, gender, and mortality in this Medieval context. Collectively, the long lives of religious-status males compared to other composite and gendered status groups suggest that they experienced a relatively comfortable existence despite periodic complaints of destitution. The postulated demographic advantage of high-status males did not materialize in the analysis, and a reevaluation of the skeletal evidence indicates that nearly 20% of these individuals died violently. Unexpectedly, moderate-status females shared a mortality profile similar to that of religious-status males and retained a demographic advantage over all other secular status groups. In contrast to the experiences of moderate-status females, low-status females had, on average, the shortest lives at St. Andrew's. This pattern is intimately linked to their restriction from crucial social and economic resources, and provides further evidence of their marginalization in York's wage-labor economy. Overall, these relationships suggest that traditional, highly stratified and gendered notions of Medieval status and mortality are not adequate for understanding the intricacies of everyday life and death at St. Andrew's.

Low birth weight, social factors, and developmental outcomes among children in the United States

We used six waves of the National Longitudinal Survey of Youth-Child Data (1986-1996) to assess the relative impact of adverse birth outcomes vis-à-vis social risk factors on children's developmental outcomes. Using the Peabody Individual Achievement Tests of Mathematics and Reading Recognition as our outcome variables, we also evaluated the dynamic nature of biological and social risk factors from ages 6 to 14. We found the following: (1) birth weight is significantly related to developmental outcomes, net of important social and economic controls; (2) the effect associated with adverse birth outcomes is significantly more pronounced at very low birth weights (< 1,500 grams) than at moderately low birth weights (1,500-2,499 grams); (3) whereas the relative effect of very low-birth-weight status is large, the effect of moderately low weight status, when compared with race/ethnicity and mother's education, is small; and (4) the observed differentials between moderately low-birth-weight and normal-birth-weight children are substantially smaller among older children in comparison with younger children.

Socioeconomic status and child development

Socioeconomic status (SES) is one of the most widely studied constructs in the social sciences. Several ways of measuring SES have been proposed, but most include some quantification of family income, parental education, and occupational status. Research shows that SES is associated with a wide array of health, cognitive, and socioemotional outcomes in children, with effects beginning prior to birth and continuing into adulthood. A variety of mechanisms linking SES to child well-being have been proposed, with most involving differences in access to material and social resources or reactions to stress-inducing conditions by both the children themselves and their parents. For children, SES impacts well-being at multiple levels, including both family and neighborhood. Its effects are moderated by children's own characteristics, family characteristics, and external support systems.

Food consumption, activity, and overweight among elementary school children in an Appalachian Kentucky community

In the U.S., child overweight is on the rise and is implicated in later adult chronic illness. Given that overweight is hardly tractable, prevention as compared to treatment is seen as a better alternative for lowering the risk of long-term health consequences. To increase the success of prevention efforts, many argue that programs must be "culturally sensitive and targeted toward specific populations at greater risk. However, there exists a limited understanding of how overweight is distributed across the landscape, among and within populations and groups. This paper reports the prevalence of overweight among 54 school children in a rural, Appalachian community with a high rate of poverty, and it compares boys to girls. Thirty-seven percent of boys and 10.3% of girls are overweight, based on the 90th percentile body mass index (BMI). Analysis of food intake indicates a pattern of food consumption that is high in fatty and sugary foods and low in fruit and vegetable consumption. Analysis of activity indicates that children report more low-intensity activity than high; that overweight children report more episodes of video/computer play compared to nonoverweight children; and that boys spend more time than girls in front of the computer/television screen.

Child growth and nutritional status in a high-poverty community in eastern Kentucky

The research reported in this paper examines the relationship between household socioeconomic measures, child growth, and nutritional status in a community in eastern Kentucky with a high rate of poverty. It is based on the premise that child growth and nutritional status reflect the social circumstances in which they occur. 21.6% of the children exhibited low height (<15th percentile of National Center for Health Statistics [NCHS] reference values), with 13% of the girls exhibiting stunting (<5th percentile). Thirty-three percent of the children exhibited overweight, and 13% exhibited obesity (>85th percentile and >95th percentile of National Health and Nutrition Examination Survey [NHANES] reference values, respectively); 21.4% of boys were obese, compared to 8.7% of girls. Analysis of variance indicated that child stature is best explained by the father's education level interacting with employment status, and by the mother's employment status interacting with household poverty level. Weight is best explained by the mother's employment status. However, the relationships among socioeconomic measures and growth outcomes differed by gender of the child. These issues are discussed in light of the anthropology literature and the situation in Bridges County, Kentucky where the research took place.