Child development: vulnerability and resilience

How researchers can translate health evidence into books for children

The health promotion literature that considers how scientific evidence can be effectively communicated tends to focus on evaluating the effectiveness of communication materials. This has resulted in a knowledge gap regarding effective knowledge translation processes. This study explores the process, reasoning and practices for developing books for children that incorporate evidence-based information to aid understanding of scientific evidence about health and environmental or natural disasters. This study is informed by a systematic review of the literature combined with responses to an email interview with authors of books for children. Nine published studies were included in the systematic review. Twenty-two authors responded to the email survey (25% response rate, following 86 invitations). We report seven key findings to guide the development of health-promoting books for children: (i) understand the needs and expectations of the audience, (ii) articulate the topic and research evidence, (iii) assemble a team with a mix of content knowledge and creative expertise, (iv) format should be chosen to suit the user group and guided by the creative team, (v) early testing with children and their support system is crucial, (vi) develop a dissemination strategy to reach the user group and (vii) engage in reflexivity through evaluation of effectiveness of messaging. The current investigation can guide the process, reasoning and practice of developing books for children that incorporate evidence about health and environmental disasters.

Food and Power in Protracted Crisis: How Systems and Institutions Influence Livelihoods, Food Security, and Nutrition

This article examines how systems and institutions influence the distribution of resources in society and, as such, affect livelihoods, food security, and nutrition. It draws on research on the political economy of food, and the governance effects of food aid practices, conducted in Sudan and Somalia and on the role of a social approach to nutrition in situations of famine and mass starvation. This article argues first for the importance of examining political structures as basic causes of malnutrition as they influence whether and how institutions function (in relation to land, markets, employment, aid, or justice). Second, this article illustrates how, in situations of crisis, the manipulation of institutions can create power for some and vulnerability to malnutrition in others. Third, it argues that a focus on treatment of malnutrition and behavior (hygiene and feeding practices) has drawn attention away from systems and institutions and feeds into discrimination as a basic cause.

The Effects of the Creator’s Situation on Creativity Evaluation: The Rater’s Cognitive Empathy and Affective Empathy Matter in Rating Creative Works

Successful intelligence theory suggests that creativity is necessary for personal achievement outside of intelligence. Unlike intelligence, creativity can develop in a supportive environment. People should consider the situation of disadvantaged groups, which are characterized by low personal achievement and a bad growth environment in creativity evaluation from a caring perspective. This study focuses on the effect of the creator’s situation on creative evaluation and the role of the rater’s empathy (i.e., cognitive empathy and affective empathy) and sympathy in creative evaluation. Four pairs of creator’s situations (by age, physical state, family situation, and economic state) were designed to represent people with disadvantages or advantages. A between-subject design was used with 590 undergraduate students randomly assigned to eight sub-conditions. The participants were asked to assess three products in eight situations. The rater’s empathy and sympathy in creativity evaluation were explored in the overall disadvantage (N = 300) and advantage (N = 290) conditions. The results showed that the participants only provided significantly higher ratings to the creative product made by a child. Cognitive empathy only predicted a creative rating under disadvantaged conditions, and affective empathy negatively moderated this effect. Affective empathy only predicted a creative rating under advantage conditions, and cognitive empathy positively moderated this effect. Affective empathy only predicted a creative rating under advantage conditions, and cognitive empathy positively moderated this effect. The possible mechanisms of the effect and implications for the establishment of a supportive environment for creativity and creativity teaching practice were discussed.

Understanding Mechanisms Driving Family Homeless Shelter Use and Child Mental Health

Homeless shelters throughout the U.S. are overcrowded and under-resourced. Families with children face substantial barriers to timely, successful shelter exit, and prolonged shelter stays threaten child mental health. This community-based system dynamics study explored barriers to timely, successful shelter exit and feedback mechanisms driving length of stay and child mental health risk. Group model building - a participatory systems science tool - and key informant interviews were conducted with clients (N = 37) and staff (N = 6) in three family homeless shelters in a Midwestern region. Qualitative content analysis with emergent coding identified key themes feedback loops. Findings indicated overcrowding delayed successful shelter exit; longer stays exacerbated crowding and stress in a vicious cycle. Furthermore, longer stays exacerbated child risk for mental disorder both directly and indirectly via crowding and caregiver stress. Capacity constraints limited families served, while contributing to ongoing unmet need. Future research should investigate the roles of these dynamic feedback relationships in the persistent vulnerability of homeless families. Service design should prioritize interventions that alleviate crowding and subsequent threats to mental health such as private or scattered-site shelter accommodations, affordable child care, and homelessness prevention to facilitate successful shelter exit and mitigate child mental health risk.

Sleep, biological stress, and health among toddlers living in socioeconomically disadvantaged homes: A research protocol

Healthy sleep is important to behavioral, neurobiological, and physiologic health. In older children and adults, stress biomarkers, such as cortisol and C-reactive protein, increase when they do not practice healthy sleep habits. However, little is known about the relationships among sleep health, stress, and health outcomes among very young children living with socioeconomic adversity, a group that is particularly at risk for poor future health. The NIH-funded study described in this protocol addresses this scientific gap to improve understanding of these relationships during a critical developmental period in children's lives-toddlerhood. We will use a longitudinal design with repeated measures to prospectively examine the relationships among sleep health, stress, and toddlers' health from age 12 to 24 months, to address the following aims: i) examine changes in subjective and objective sleep health measures; ii) examine changes in stress biomarkers; iii) examine the cross-sectional and longitudinal relationships between sleep health measures and stress response; and iv) examine the cross-sectional and longitudinal relationships between sleep health measures, stress biomarkers, and toddlers' behavioral health. The sample will include 113 toddlers and their caregivers. We are collecting subjective and objective data on sleep health, multi-systemic biomarkers of stress, and toddlers' behavioral health. Generalized linear models will be used in the data analyses. Results from this study will be used to support development and testing of interventions, such as those that may improve sleep, among young children at risk for toxic stress.

“Developing Holistic Nursing Interventions to Improve Adolescent Health”

Adolescents learn health behaviors in a sociocultural context of community, family, and peers. Although many adolescents engage in behaviors that protect and promote health, others engage in behaviors that threaten or compromise their health. The purpose of this review article is to provide an overview of health-risk behaviors and the morbidities and mortalities of adolescence that are related to these behaviors. Interventions that address these health behaviors and outcomes are presented along with suggestions for a holistic nursing response to this important public health concern.

Resilience in rural left-behind middle school students in Yunyang county of the Three Gorges area in China: a prospective cohort study

BACKGROUND

The number of left-behind children in China is gradually increasing. This study aimed to understand the mental health status and changes in resilience of rural, left-behind middle school students in Yunyang County of the Three Gorges area in China.

METHODS

A prospective cohort study, including two follow-up surveys, with a frequency of once every 6 months was conducted among middle school students in Yunyang County. A self-designed questionnaire was used to obtain socio-demographic factors of participants, the Mental Health Test (MHT) scale was used to assess their mental health statuses, and resilience levels were collected using Resilience Youth Development Module (RYDM) scale at baseline and at the first and second follow-up investigations.

RESULTS

Of the 1401 students who completed the baseline survey, 1322 students were eligible for the cohort study, of whom 1160 were investigated in the first follow-up survey. Ultimately, 1101 students completed the 1-year cohort. The detection rate of mental health problems for middle school students in the rural Three Gorges area was 5.64 %, and there was no significant difference between left-behind students (LBS) and non-left-behind students (NLBS) (χ (2) = 1.056, P = 0.304). The detection rates of medium resilience rose gradually (Z = 4.185, P = 0.000), while that of high resilience declined gradually (Z = 4.192, P = 0.000) in the baseline, first and second follow-up investigations. There was no significant difference between LBS and NLBS in resilience level (P > 0.05). The average RYDM scores were 2.990, 2.926, 2.904 among LBS in the baseline, first and second follow-up investigation, respectively, and the effect of time on the average RYDM scores was significant (F = 14.873, P = 0.000). The average MHT scores in LBS were 41.54, 39.79, 38.84 in the baseline, first and second follow-up investigations, respectively, and the detection rates of students who had psychological problems increased gradually (Z = 4.651, P = 0.000). The simple correlation coefficients between the RYDM and MHT scores were-0.227,-0.158, and-0.204 in the baseline, first and second follow-up survey, respectively (P = 0.000).

CONCLUSIONS

The detection rate of mental health problems for middle school students in the rural Three Gorges area is relatively low and most of the LBS in area have medium or high resilience. The mental health status of LBS positively correlated with their resilience levels. Resilience declined gradually as time went on, but further studies with longer follow-up durations are needed to confirm the variation of resilience.

Contributions of a Child's Built, Natural, and Social Environments to Their General Cognitive Ability: A Systematic Scoping Review

The etiology of a child’s cognitive ability is complex, with research suggesting that it is not attributed to a single determinant or even a defined period of exposure. Rather, cognitive development is the product of cumulative interactions with the environment, both negative and positive, over the life course. The aim of this systematic scoping review was to collate evidence associated with children’s cognitive health, including inherent factors as well as chemical and non-chemical stressors from the built, natural, and social environments. Three databases were used to identify recent epidemiological studies (2003–2013) that examined exposure factors associated with general cognitive ability in children. Over 100 factors were evaluated from 258 eligible studies. We found that recent literature mainly assessed the hypothesized negative effects of either inherent factors or chemical exposures present in the physical environment. Prenatal growth, sleep health, lead and water pollutants showed consistent negative effects. Of the few studies that examined social stressors, results consistently showed cognitive development to be influenced by both positive and negative social interactions at home, in school or the community. Among behavioral factors related to diet and lifestyle choices of the mother, breastfeeding was the most studied, showing consistent positive associations with cognitive ability. There were mostly inconsistent results for both chemical and non-chemical stressors. The majority of studies utilized traditional exposure assessments, evaluating chemical and non-chemical stressors separately. Collective evidence from a limited number of studies revealed that cumulative exposure assessment that incorporates multiple chemical and non-chemical stressors over the life course may unravel the variability in effect on cognitive development and help explain the inconsistencies across studies. Future research examining the interactions of multiple stressors within a child’s total environment, depicting a more real-world exposure, will aid in understanding the cumulative effects associated with a child’s ability to learn.

Are resilience and maternal sense of coherence associated with gingival status in adolescents from low-income families?

BACKGROUND

The capacity to overcome social disadvantages and maintain oral health through psychosocial processes remains poorly understood in children.

AIM

This study assessed the relationship of children's resilience and maternal sense of coherence (SOC) with gingival status in children from low-income families.

METHODS

A cross-sectional study was conducted on 190 schoolchildren aged 11-12 years and their mothers. Family socioeconomic characteristics and housing conditions, maternal and children's oral cleanliness behaviours (tooth brushing and dental floss use), maternal SOC, children's resilience, and demographic data were collected through interviews with children and their mothers. Validated versions of Antonovsky's scale and the resilience scale were used to assess mother's SOC and children's resilience. Gingival status and dental plaque of children were evaluated through clinical examinations using bleeding on probing index and plaque index. Statistical analysis included Pearson's correlation and hierarchical multinomial ordinal logistic regression analyses.

RESULTS

The mean frequency of gingival bleeding in the sample was 8.4% (SD: 8.5). Children with higher levels of resilience showed 31% lower odds of gingival bleeding (OR: 0.7; 95% CI: 0.4-0.9) after adjustment for socioeconomic characteristics, children's and mothers' use of dental floss.

CONCLUSIONS

Children's resilience was a psychosocial factor associated with gingival conditions.

Validation of a rapid neurodevelopmental assessment tool for 5 to 9 year-old children in Bangladesh

OBJECTIVE

To validate a rapid neurodevelopmental assessment tool for use by child care professionals to determine neurodevelopmental impairments (NDIs) in children ages 5-9 years (61-108 months) in Bangladesh.

STUDY DESIGN

In a convenience sample of community children (n = 18), interrater reliability was determined between 6 testers. Validity was determined in 121 children by simultaneous administration of a test of adaptive behavior (AB) (ie, the Independent Behavior Assessment Scale, or Gold Standard I) and IQ tests (Wechsler Preschool and Primary Scales of Intelligence or the Wechsler Intelligence Scales for Children, or Gold Standard II) by child psychologists.

RESULTS

Interrater reliability was excellent (kappa = 1.00). Significantly lower scores were obtained on AB and IQ tests in those identified with "any (≥1) NDI" and most specific NDIs. Sensitivity and specificity for "any NDI" with (a) "significant difficulties" (defined as AB z-scores < -2 SD and/or IQ < 70) or (b) "mild difficulties included" (AB z scores < -1 SD and/or IQ < 85) were 84% and 57%; and 83% and 70%, respectively.

CONCLUSION

The rapid neurodevelopmental assessment tool shows promise as a tool for use by a range of professionals for identifying NDIs in children of primary school age. Further refinement for identifying specific impairments is needed.

Effect of Poverty Reduction Program on Nutritional Status of the Extreme Poor in Bangladesh

Background

Poverty alleviation programs for the extreme poor improve participants' economic status and may impact other important outcomes that are seldom evaluated. A program targeted to the extreme poor by BRAC, a development organization in Bangladesh, has been successful in significantly alleviating extreme poverty.

Objective

We hypothesized that the program also improved the nutritional status of women and preschool children.

Methods

A nonequivalent control, pre- and posttest quasi-experimental design that was longitudinal at the village level was used to test the hypotheses. Data were collected from a random sample of 4,131 children and 3,551 women from 3,409 households in 159 villages of 3 northern districts of Bangladesh in 2002 and 2006. Linear mixed random-intercept models accounted for clustering effects and potential confounders.

Results

The weight-for-height of children between 24 and 35 months of age from program households was significantly higher ( p < .05) than that of children from control households. We found no significant differences between control and program households in three other growth and body-composition indicators in three other age categories of preschool children or in women.

Conclusions

These results are important, as this is a large-scale program that has already been extended to more than half the country. The findings will contribute to judging the cost-benefit and cost-effectiveness of the program and in garnering support for the expansion of such programs.

The effects of a school-based psychosocial intervention on resilience and health outcomes among vulnerable children

Responding to the psychosocial health needs of the vulnerable population has been considered as a significant public health issue that must be addressed through access to public health professionals. The study adopted a quasi-experimental design to evaluate the impact of a training program on nurses and teachers' knowledge of psychosocial health needs of vulnerable children and the impact this had on children's resilience and psychosocial health outcomes (self-esteem, social connection, anxiety, and depression). The result showed a significant increase in the knowledge mean scores of both nurses and teachers 6 weeks post intervention. Children's depression scores significantly reduced post intervention. Their resilience, self-esteem, and social connection were also significantly improved, while no significant reduction was found in their anxiety scores. The results of the pilot study suggest that a more rigorous study be conducted to further ascertain the effectiveness of the various interventions used in this study while taking into consideration the challenges raised by the authors.

Nutritional status of Palestinian preschoolers in the Gaza Strip: a cross-sectional study

BACKGROUND

The authors examined factors associated with nutritional resilience/vulnerability among preschoolers in the Gaza Strip in 2007, where political violence and deprivation are widespread.

METHODS

This cross-sectional study was carried out in 2007 using random sampling of kindergartens in order to select 350 preschoolers. Binary logistic regression was used to compare resilient (adequate nutrition) and vulnerable (stunted) groups with those with moderate nutrition.

RESULTS

Approximately 37% of the subjects demonstrated nutritional resilience and 15% were vulnerable. Factors associated with nutritional resilience were child younger age, normal birth weight, actively hand- or spoon-feeding when the child was below two years, and residential stability in the past two years. The only factor associated with nutritional vulnerability was lower total score on the mother's General Health Questionnaire, which we interpret as a marker of maternal mental health.

CONCLUSIONS

Children with low-birth weight and older children had worse nutritional resiliency outcomes. Further, poorer outcomes for children were associated with lower maternal mental health status, as well as increased family residential instability. Our results add to the large literature on the pervasive effects of violence and instability on children and underscore the need for resources for early intervention and for the urgent resolution of the Palestinian and other armed conflicts.

Relation between childhood maltreatment and severe intrafamilial male-perpetrated physical violence in Chinese community: the mediating role of borderline and antisocial personality disorder features

This study investigates the role of borderline personality disorder (BPD) and antisocial personality disorder (ASPD) features as mediators of the effects of childhood maltreatment on severe intrafamilial physical violence amongst Chinese male perpetrators. A cross-sectional survey and face-to-face interview were conducted to examine childhood maltreatment, personality disorder features, impulsivity, aggression, and severe intrafamilial physical violence in a community sample of 206 abusive men in China. The results suggest that ASPD or BPD features mediate between childhood maltreatment and intimate partner violence perpetration in Chinese abusive men. These findings may yield clinical and forensic implications for assessing the psychopathology of abusive men, and may steer the intervention of intimate partner violence.

[The role of life events in mothers of malnourished children: the other side of malnutrition]

The objective of this article is to describe the life story of mothers of malnourished children and their possible associations to socio-demographic and psychosocial aspects. It is a cross sectional study carried out in a public health basic unit in Porto Alegre (RS, Brazil), with a total of 82 mothers. It was used a structured questionnaire with socio demographic, reproductive variables and mothers' live events. A descriptive analysis and chi-square were used to investigate possible associations among the selected variables. Mothers had low schooling, low income and were multiparous besides, suffered parental abuse, had negative experiences with alcoholic parents (67%), were neglect in infancy (65%), have rejected the undernourished baby during pregnancy (70%). They related depression symptoms during pregnancy (70%) and postpartum (60%). The study showed a difference of proportion between mothers who suffered abuse in childhood and those who not suffered according to pregnancy rejection (p<0,001), depression during the pregnancy and after delivery (p<0,001). This study associated mother's life stories with live events that, beyond the social and economic disadvantage, could develop a weak interaction between mother-baby that contribute to malnutrition.

Health-related quality of life of Palestinian preschoolers in the Gaza Strip: a cross-sectional study

Background

Research on children's responses to wartime trauma has mostly addressed Post-Traumatic Stress Disorder (PTSD). However, PTSD is only one aspect of a complex set of responses. This study proposes to expand knowledge of well-being in children exposed to political violence through widening the conceptualization of well-being beyond PTSD, morbidity, and mortality by measuring health-related quality of life (HRQOL) and its facets, physical health, and psychosocial health.

Methods

In 2007, we used a cross-sectional random sample of kindergartens to examine factors associated with HRQOL, as measured by the PedsQL 4.0, in 350 preschoolers in the Gaza Strip, Palestine, where political violence and deprivation are widespread.

Results

About 65% of the mothers reported severely impaired psychosocial and emotional functioning in their children. Preschoolers had lower HRQOL than the US reference sample and samples of children in other low income countries with large effect size. HRQOL was comparable to those of US children with several chronic diseases. Factors associated with lower HRQOL were older child age, male gender, and more exposures to traumatic events. Factors associated with HRQOL subscales were for lower psychosocial health: older child age, history of food, water, and electricity deprivation during incursion, and witnessing assassination of people by rockets. For lower physical health: older child age, history of food, water, and electricity deprivation during incursion, and having heard of a killing of a friend by soldiers.

Conclusions

HRQOL, including psychosocial health and emotional functioning is often severely impaired among preschoolers in the Gaza Strip. Exposure to both violent and non-violent negative events was associated with HRQOL in preschoolers.

The social determinants of early child development: an overview

AIM

This paper offers an overview of the current state of knowledge of the critical social determinants of child development and the complex ways in which these can influence health trajectories.

METHODS

We conducted an overview of the research conducted by medical and social scientists in the attempt to uncover the conditions under which children reach optimal health and developmental.

RESULTS

The first years of life represent a critical period during which trajectories of health vulnerability are determined by the complex interplay between biological, genetic, and environmental conditions.

CONCLUSIONS

There are fundamental principles of optimal child development that apply to all human beings, regardless of language and culture.

An integrative model of adolescent health risk behavior

Nursing research in adolescent health risk behavior is lacking because there are few comprehensive nursing models to guide it. Nurses need to understand what influences adolescents to engage in health risk behavior or to refrain from it. The Integrative Model of Adolescent Health Risk Behavior was developed to guide adolescent nursing research using existing theoretical and empirical data. Components include protective/escalatory factors, risk stimulus, maturity of judgment (as a meditational influence), and the risk decision (dichotomized into risk avoidance and taking). The model will facilitate development of nursing interventions to increase health protection by discouraging adolescents from making unhealthy choices.

Health-promoting lifestyles of university students in mainland China

BACKGROUND

Health-promoting lifestyles of adolescents are closely related to their current and subsequent health status. However, few studies in mainland China have examined health-promoting behaviors among university students, notwithstanding the dramatic development of higher education over the past two decades. Moreover, no study has applied a standardized scale to such an investigation. The adolescent health promotion (AHP) scale has been developed and is commonly used for measuring adolescent health-promoting lifestyles in Taiwan. The aim of this study is to determine the appropriateness of the AHP for use in mainland China.

METHODS

A cross-sectional study was performed on a total of 420 undergraduates, who were randomly selected using a two-stage stratified sampling method in a university in Guangzhou city, mainland China. The simplified Chinese version of the AHP scale, comprising six dimensions (Nutrition behavior, Social support, Life-appreciation, Exercise behavior, Health-responsibility and Stress-management), was used to measure health-promoting lifestyles among undergraduates. The reliability of the AHP scale was assessed using split-half reliability coefficients, intraclass correlation coefficients and Cronbach's alpha coefficient. Validity was assessed by factor analysis and correlation analysis. Factors associated with health-promoting lifestyles were identified using multiple linear regression.

RESULTS

Cronbach's coefficients were greater than 0.7 in all dimensions of the AHP scale except for Nutrition behavior (0.684). Intraclass correlation coefficients ranged from 0.689 to 0.921. Split-half reliability coefficients were higher than 0.7 in three AHP dimensions (Social support, Life-appreciation and Exercise behavior). Our results were generally in accordance with the theoretical construction of the AHP scale. The mean score for each of the six dimensions was lower than 70. Gender and grade were the factors primarily associated with health-promoting lifestyles among undergraduates.

CONCLUSION

The AHP is a valid and reliable instrument for assessing health-promoting lifestyles of undergraduates in mainland China, which remain at a low level. Health behavior education taking account of gender and grade differences may also be applied.

Saving lives, preserving livelihoods: understanding risk, decision-making and child health in a food crisis

The purpose of this paper is to analyse household decision-making regarding resource allocation in the aftermath of a food crisis in rural Niger. International attention had resulted in humanitarian agencies launching emergency nutrition programmes to alleviate persistently high levels of acute child malnutrition. We conducted participant observation, 93 in-depth interviews, 15 focus groups, 44 feeding and illness histories for children under 5, and debriefing sessions with local humanitarian staff. The impetus for this study came from observations of marked intra-household differences in child growth and health status, despite the caregivers' ethos of treating children equally. Egalitarian input, however, does not always result in equal outcomes: vulnerable children become "victims of non-discrimination" through a form of benign neglect engendered by pervasive poverty. The ethos and practices of equal investment in children are rooted in a need to balance the perceived risks to children with the preservation of long-term livelihoods. We discuss the mismatch of views between external interventions, which focus on saving individual children's lives, and local priorities, aimed at spreading risk. This mismatch is rooted in the different ways in which humanitarian agencies and local communities weigh up risks and vulnerabilities in matters of child health.

A escola e as perspectivas educacionais de jovens em situação de risco

Este estudo visou identificar a percepção de jovens em situação de risco psicossocial sobre a realização e aspirações escolares e a rede de apoio social relacionadas ao contexto de ensino-aprendizagem. Investigou proteção e vulnerabilidade no contexto escolar, com base na Abordagem Ecológica do Desenvolvimento e a Psicologia Positiva. 852 jovens, de ambos os sexos, do ensino médio público de regiões administrativas do Distrito Federal responderam a um questionário sobre relações com professores e amigos, qualidade e importância da escola, reprovação e fracasso escolar e rede de apoio social e afetiva. Os resultados revelaram que a escola se constitui numa importante rede de proteção, com a qual os jovens apresentam, em geral, atitudes positivas de confiança e interesse. A continuidade da formação é valorizada e a escola está incluída em projetos futuros destes jovens. Os amigos, professores e pais representam importantes fatores de proteção no contexto escolar.

Community violence in context: risk and resilience in children and families

Although some community violence research has examined the context of community violence, including the social, economic, and structural organization of neighborhoods, more needs to be learned about family, school, and community-level factors that may promote and lessen the incidence and prevalence of community violence. In addition, further research is needed on various social, environmental, and contextual factors hypothesized to protect youth from exposure. This article (a) reviews and examines the relation between neighborhood context and risk of violence exposure, (b) reviews current literature on predictors of community violence and mental health and behavioral consequences for children and families adversely affected by community violence, (c) examines sources of resilience and community strengths that extend beyond the individual, (d) discusses the contributions and limitations of current conceptualizations of risk and resilience, and (e) highlights directions for future research. Information from this review can inform community and government efforts to lessen community violence through prevention and treatment.

Developmental risks and psychosocial adjustment among low-income Brazilian youth

Exposure to developmental risks in three domains (community, economic, and family), and relations between risks and psychosocial well-being, were examined among 918 impoverished Brazilian youth aged 14-19 (M = 15.8 years, 51.9% female) recruited in low-income neighborhoods in one city in Southern Brazil. High levels of developmental risks were reported, with levels and types of risks varying by gender, age, and (to a lesser extent) race. Associations between levels of risks in the various domains and indicators of psychological (e.g., self-esteem, negative emotionality) and behavioral (e.g., substance use) adjustment differed for male and female respondents. Findings build on prior research investigating the development of young people in conditions of pervasive urban poverty and reinforce the value of international research in this endeavor.

Responsive complementary feeding in rural Bangladesh

It is now widely recognized that malnutrition can partly be attributed to caregiver-child interaction during feeding episodes. Current conceptual frameworks emphasize the importance of responsiveness (including active and social behaviour), psychomotor abilities of the child to self-feed, and a non-distracting feeding environment. The present observational study had three main objectives: (1) to define operationally key terms such as responsive and active feeding and observe their frequency in a rural Bangladesh sample; (2) to examine whether self-feeding, responsive and active behaviours of the mother and child varied with child's age and amounts eaten; and (3) to determine associations between mother and child behaviours. Fifty-four mother-child pairs were observed during one feeding episode and behaviours were coded for 5 categories, namely self-feeding, responsive, active, social and distracting behaviours. Children were between 8 and 24 months of age. Results indicated that the five behaviours could be observed and reliably coded. Two-thirds of mothers had an active feeding style but only a third were responsive; the two styles did not overlap. With older children, mothers encouraged more eating and more self-feeding, but children did not feed themselves more; instead older children were more negatively responsive (refusing offered food). Positively responsive mothers tended to have active children who explicitly signaled their desire for food or water, and who ate more mouthfuls of food. Positively active mothers adopted different strategies to encourage eating, such as verbally directing the child to eat, focusing, and temporarily diverting. These mothers tended to have children who were negatively responsive and refused food. Children accepted on average 5.31 mouthfuls of food and rejected 2.13. Mothers who used intrusively active strategies (e.g. force feeding) tended to have children who were both positively and negatively responsive, thus partially reinforcing her forceful behaviour. Thus, the responsive feeding framework, once operationalized, has the potential to identify specific behaviours that support or impede mother-child interaction during complementary feeding.

[Violence is also a public health issue]

In 1996, the World Health Organization declared violence a major and growing public health problem across the world. In Spain, despite the growing incidence of reports of deaths and abuse due to intimate partners violence; the emergent data on school-based violence among children and adolescents; the persisting political violence and the tragic experience of the 11-M attacks in Madrid; a clear positioning over the role of the public health structures in the study and intervention of violence has not taken place. This article provides a characterization of the impact of violence in the health of its victims, as derived from a non-systematic review of the clinical, psychological and social literature. It also includes some prevalence data from Spanish studies. Special emphasis is given to violence against women, and political violence. The article highlights the scarcity of epidemiological data, which hinders the assessment of the health impact of violence in Spain. It brings, instead, the opinions of a number of public health professionals over the role of the Spanish communities of epidemiology and public health in this matter. The article concludes with a call to public health professionals, including the Spanish scientific societies involved in public health, to facilitate the public debate leading to the definition of the role of the Spanish public health in the understanding and reduction of the impact of violence on the health of its victims.

Contextualizing community violence and its effects: an ecological model of parent-child interdependent coping

This article presents an integrated conceptual framework that contextualizes exposure to community violence and the interpersonal and interdependent processes of parent and child response to community violence. This model posits that parental distress, including post-traumatic stress disorder (PTSD) and depression, is a significant mediator of child distress symptomatology and behavior problems. The model advances understanding of the impact of community violence in the lives of parents and children through various mechanisms, including social capital. This article underscores the need for a fundamental shift in the study of community violence, in the delivery of mental health services, and in prevention efforts from focusing on the individual child to concentrating on the parent, family, and community-level factors and processes. This article highlights important areas to address in future research, including investigation and specification of the mechanisms and processes by which neighborhoods affect and influence human development outcomes.

Iron deficiency and physical growth predict attainment of walking but not crawling in poorly nourished Zanzibari infants

Locomotion allows infants to explore their environment, promoting development in other domains. Motor progression involves biological systems and experiential factors. Nutritional deficiencies could interfere with systems involved in locomotion. This study examined the associations between height-for-age (HAZ), weight-for-height (WHZ) Z-scores and anemia-iron status on locomotion in 646 Zanzibari infants. Motor milestones were assessed by trained observers using a 14-item scale. Two mutually exclusive samples were created. The crawling sample (n = 167, 6-18 mo old) included infants that crawled only or did not crawl; the walking sample (n = 479, 9-18 mo old) included children that walked alone or did not walk alone. Of the crawling and walking samples, 82.6 and 83.9% respectively, were iron deficient and/or anemic (hemoglobin < 100 g/L; zinc protoporphyrin > or = 90 micromol/mol heme). Stunting (HAZ less than -2) occurred in 30.5% of the crawling sample and 38.4% of the walking sample. Logistic regression models estimated the influence of factors on crawling vs. not crawling or walking vs. not walking. Two models were tested: 1) included sex, age, SES, HAZ and WHZ; 2) added anemia-iron status category to Model 1. HAZ improved the odds of crawling by 30%, but was not significant in either model. Model 2 fit the walking sample data best (P < 0.0001); an increase in HAZ doubled the odds of walking and nonanemic, noniron deficient children were 66% more likely to walk than those with anemia and/or iron deficiency. In this sample of poorly nourished infants, growth and anemia-iron status are significant predictors of walking, but not crawling.

Resiliência e promoção da saúde

Resiliência refere-se a capacidade dos seres humanos em enfrentar e responder de forma positiva às experiências que possuem elevado potencial de risco para sua saúde e desenvolvimento. Falar de resiliência significa, portanto, falar de produção de saúde em contextos adversos. Com o objetivo de responder ao que faz com que uma família, mesmo vivendo em um contexto adverso, tenha uma prática de cuidado capaz de criar as condições para que seus membros construam uma trajetória de vida que pode ser considerada resiliente, é discutido o conceito de resiliência e sua aproximação com o de promoção da saúde, apontando algumas ações que podem potencializar as ações dos profissionais que trabalham com famílias em situação de risco, tais como o deslocamento da ênfase da dimensão de negatividade da doença, para as potencialidades das pessoas/famílias; a articulação de ações intersetoriais e interdisciplinares, compatibilizando políticas públicas saudáveis e a ampliação de medidas protetoras à saúde.

Discerning Community Resilience in Disadvantaged Communities in the Context of Violence and Injury Prevention

The study of community resilience is a relatively under-explored area. Accordingly, in an attempt to further our understanding of community resilience, we present a study focused on the development of a questionnaire to assess and delineate the nature of community resilience across three low socio-economic neighbourhoods in the Western Cape. The study embraced a participatory framework that incorporated several phases. Data indicated significant associations between some of the dimensions of community resilience, namely, neighbourhood cohesion and community hope ( p<0.001, Fisher-Exact); community structures and leadership and social supports ( p<0.05, Fisher-Exact); the ownership of a business and physical security ( p<0.001, Chi-squared); and the ownership of a business and social supports ( p<0.05, Chi-squared). However, some of the community resilience measures, such as the knowledge of treatment of injuries yielded no associations with any of the other measures. Using the Chi-squared test, it was found that there were significant differences between the three communities on three of the resiliency measures: neighbourhood cohesion ( p<0.001), knowledge of treatment of injuries ( p<0.001), and community structures and leadership ( p<0.001). The results suggested that communities may have the capacity to develop resilient responses and that these responses differ across neighbourhoods. By way of conclusion, we discuss the findings and review the implications for the further conceptualisation and operationalisation of the notion of community resilience.

Risco e proteção: em busca de um equilíbrio promotor de resiliência

O artigo analisa a relação da resiliência com eventos de vida desfavoráveis e fatores de proteção. A amostra do estudo foi de 997 adolescentes escolares da rede pública de ensino de São Gonçalo/RJ. Como medida de resiliência utilizou-se a Escala de Resiliência desenvolvida por Wagnild e Young (1993). Para medir eventos de vida foram utilizadas escalas de violência física (Straus, 1979) e psicológica (Pitzner & Drummond, 1997), itens de violência na escola e na localidade, violência entre irmãos e entre pais, e violência sexual entre outros. Como fatores de proteção utilizou-se: Escala de Apoio Social de Shebourne e Stewart (conforme citado por Chor, Grip, Lopes & Farstein, 2001), Escala de Auto-Estima (Rosemberg, 1989), itens abordando supervisão familiar, relacionamento com amigos e professores. Os eventos de vida negativos não apresentaram relação com a resiliência, enquanto os fatores de proteção mostraram-se todos correlacionados com o constructo.

Recidivism and resilience in juvenile sexual offenders: an analysis of the literature

The majority of research that exists studying juvenile sex offenders (JSOs) is dominated by the predilection that identifying risk factors associated with recidivism will benefit both the JSOs and treatment providers. Further, the majority of existing treatments are guided by research that has identified what makes JSOs more likely to reoffend. Absent from the majority of the literature is an examination of the strengths and positive characteristics demonstrated by JSOs that may prove useful in both reducing recidivism and increasing the likelihood of achieving positive outcomes (i.e., demonstrating resilience). Research examining known risk factors for sexual and nonsexual recidivism is described. Next, literature on resilience is reviewed, followed by a discussion of this literature in the context of treatment for JSOs. Finally, future directions of research are presented.

Youth Resilience Framework for reducing health-risk behaviors in adolescents

Adolescents engage in risky behaviors that compromise their health. Leading causes of morbidity and mortality are associated with a few preventable health-risk behaviors initiated in childhood and early adolescence. Interventions that enhance protective factors in childhood are needed to offset these vulnerabilities and thus promote the health of adolescents. The Youth Resilience Framework is presented that addresses individual and sociocultural risk factors and protective resources that can influence health outcomes throughout adolescence. This framework incorporates a developmental approach to address precursors and health-risk behaviors that may be amenable to early health-promoting interventions.

Street Children, Human Rights, and Public Health: A Critique and Future Directions

▪ Abstract  This review presents a critique of the academic and welfare literature on street children in developing countries, with supporting evidence from studies of homelessness in industrialized nations. The turn of the twenty-first century has seen a sea change of perspective in studies concerning street youth. This review examines five stark criticisms of the category “street child” and of research that focuses on the identifying characteristics of a street lifestyle rather than on the children themselves and the depth or diversity of their actual experiences. Second, it relates the change of approach to a powerful human rights discourse—the legal and conceptual framework provided by the United Nations Convention on the Rights of the Child—which emphasizes children's rights as citizens and recognizes their capabilities to enact change in their own lives. Finally, this article examines literature focusing specifically on the risks to health associated with street or homeless lifestyles. Risk assessment that assigns street children to a category “at risk” should not overshadow helpful analytical approaches focusing on children's resiliency and long-term career life prospects. This review thus highlights some of the challenging academic and practical questions that have been raised regarding current understandings of street children.

Community factors in the development of resiliency: considerations and future directions

Researchers have questioned why some children and adolescents are more resilient than others in the face of adversity and have identified several protective factors. The present paper focuses on one of these variables, namely, support from caring adults in the community. We present a brief review of this component of the resiliency literature along with a discussion of some of the issues and challenges raised by the findings. It is suggested that the evidence is substantial enough and the possible rewards associated with exploiting these findings considerable enough to warrant mounting wide-scale community-based efforts to assist vulnerable youth.

Predicting longitudinal growth curves of height and weight using ecological factors for children with and without early growth deficiency

Growth curve models were used to examine the effect of genetic and ecological factors on changes in height and weight of 225 children from low income, urban families who were assessed up to eight times in the first 6 y of life. Children with early growth deficiency [failure to thrive (FTT)] (n = 127) and a community sample of children without growth deficiency (n = 98) were examined to evaluate how genetic, child and family characteristics influenced growth. Children of taller and heavier parents, who were recruited at younger ages and did not have a history of growth deficiency, had accelerated growth from recruitment through age 6 y. In addition, increases in height were associated with better health, less difficult temperament, nurturant mothers and female gender; increases in weight were associated with better health. Children with a history of growth deficiency demonstrated slower rates of growth than children in the community group without a history of growth deficiency. In the community group, changes in children's height and weight were related to maternal perceptions of health and temperament and maternal nurturance during feeding, whereas in the FTT group, maternal perceptions and behavior were not in synchrony with children's growth. These findings suggest that, in addition to genetic factors, growth is dependent on a nurturant and sensitive caregiving system. Interventions to promote growth should consider child and family characteristics, including maternal perceptions of children's health and temperament and maternal mealtime behavior.