Quality of the home, daycare and neighborhood environment and the cognitive development of economically disadvantaged children in early childhood: A mediation analysis

Place-Based Child Opportunity at Birth and Child Development from Infancy to Age 4

OBJECTIVE

The objective of this study was to evaluate whether the children's neighborhood quality, as a measure of place-based social determinants of health, is associated with the odds of developmental delay and developmental performance up to the age of 4 years.

STUDY DESIGN

Mothers of 5702 children from the Upstate KIDS Study, a longitudinal population-based cohort of children born from 2008 through 2010, provided questionnaire data and a subset of 573 children participated in a clinic visit. The Child Opportunity Index 2.0 was linked to home census tract at birth. Probable developmental delays were assessed by the Ages and Stages Questionnaire up to 7 times between 4 and 36 months, and developmental performance was assessed via the Battelle Developmental Inventory at the age of 4 years.

RESULTS

In unadjusted models, higher neighborhood opportunity was protective against developmental delays and was associated with slightly higher development scores at age 4. After adjusting for family-level confounding variables, 10-point higher Child Opportunity Index (on a 100-point scale) remained associated with a lower odds of any developmental delay (OR = .966, 95% CI = .940-.992), and specifically delays in the personal-social domain (OR = .921, 95% CI = .886-.958), as well as better development performance in motor (B = 0.79, 95% CI = 0.11-1.48), personal-social (B = 0.64, 95% CI = 0.003-1.28), and adaptive (B = 0.69, 95% CI = 0.04-1.34) domains at age 4.

CONCLUSIONS

Community-level opportunities are associated with some aspects of child development prior to school entry. Pediatric providers may find it helpful to use neighborhood quality as an indicator to inform targeted developmental screening.

Nutritional Status and Poverty Condition Are Associated with Depression in Preschoolers

Consensus has been reached that symptoms of depression can begin as early as preschool. Nevertheless, only few studies have associated environmental (malnutrition) and social factors (poverty condition, access to health systems, etc.) to the onset of depression in preschoolers. The aim of this study was to explore possible associations between malnutrition (underweight, overweight/obesity), poverty status (home quality, overcrowding), access to healthcare systems and the presence of depressive symptoms in the preschoolers of a semi-rural community. In total, 695 children between 3 and 6 years from the municipality of Chiconcuac, Mexico were evaluated for symptoms of depression with the Preschool Depression Scale for Teachers (ESDM 3-6). Additionally, they were assessed for nutritional status and divided into three groups (low weight, normal weight, overweight/obesity), and their parents were asked to fill out a social demographic questionnaire. Malnutrition status OR = 2.702, 95% CI [1.771-4.145]; UW OR = 4.768, 95% CI [2.570-8.795] and OW/OB OR = 1.959, 95% CI [1.175-3.324]; poverty condition per se OR = 1.779, 95% CI [0.9911-2.630]; housing quality OR = 2.020, 95% CI [0.9606-2.659] and overcrowding = 1.619, 95% CI [0.8989-4.433] were associated to a greater risk for children to show depressive symptoms (DS). Access to healthcare was negatively related with the risk of presenting DS (OR = 0.660, 95% CI [0.3130 to 1.360]). Social and environmental factors such as malnutrition, home quality and overcrowding may increase the risk of presenting DS as soon as in preschool.

Environmental opportunities facilitating cognitive development in preschoolers: development of a multicriteria index

Access to environmental opportunities can favor children's learning and cognitive development. The objectives is to construct an index that synthesizes environmental learning opportunities for preschoolers considering the home environment and verify whether the index can predict preschoolers' cognitive development. A quantitative, cross-sectional, exploratory study was conducted with 51 preschoolers using a multi-attribute utility theory (MAUT). The criteria used for drawing up the index were supported by the literature and subdivided in Group A "Resources from the house" extracted from HOME Inventory including: (1) to have three or more puzzles; (2) have at least ten children's books; (3) be encouraged to learn the alphabet; (4) take the family out at least every 2 weeks. Group B "Screens" (5) caution with using television; (6) total screen time in day/minutes. Group C "Parental Schooling" (7) maternal and paternal education. Pearson correlation analyses and univariate linear regression were performed to verify the relationship between the established index with cognitive test results. The index correlated with the total score of the mini-mental state exam (MMC) and verbal fluency test (VF) in the category of total word production and word production without errors. Multicriteria index explained 18% of the VF (total word production), 19% of the VF (total production of words without errors) and 17% of the MMC. The present multicriteria index has potential application as it synthesizes the preschooler's environmental learning opportunities and predicts domains of child cognitive development.

Factors Associated with Motor Competence in Preschoolers from a Brazilian Urban Area

Background

Preschool is a crucial period for developing motor skills.

Objective

This study evaluated factors associated with motor competence in preschoolers from a Brazilian urban area.

Methods

A total of 211 preschoolers (51.2% girls and 48.8% boys) were evaluated. Body mass index was calculated; the Brazilian Economic Research Criterion, the Mini-Mental Scale (MMC) and the Early Childhood Environment Rating Scale®, Revised (ECERS-R™) were applied; the Habitual Physical Activity time was recorded; the Test of Gross Motor Development (TGMD-2) was performed. Univariate analysis was performed using simple linear regression for the independent variables, considering the motor test subscales as dependent variables. Variables with p < 0.20 in the univariate analysis were considered for the multiple linear regression model and were entered into the stepwise method.

Results

The independent variables remaining in the Standard Score Locomotor model were BMI, presence of park at school, and MMC (R2 = 0.16). The independent variables remaining in the Standard Object Control score were MMC and gender (R2 = 0.03). The variables associated with the highest scores of Gross Motor Quotient were MMC, body mass index, and presence of a park at school, respectively (R2 = 0.11).

Conclusion

Male eutrophic preschoolers who are physically active and attend schools with parks or courtyards in a Brazilian urban area have the highest scores for global cognitive function and motor competence.

Is body fat mass associated with worse gross motor skills in preschoolers? An exploratory study

We compared the motor competence between overweight/obese and eutrophic preschoolers with similar physical activity levels, age, socioeconomic status, maternal education, quality of the home environment and quality of the school environment. We also investigated to what extent excess body fat mass explains gross motor skills in preschoolers. A cross-sectional quantitative and exploratory study was conducted with 48 preschoolers assigned into eutrophic and overweight/obese groups. Overweight/obese preschoolers had worse Locomotor subtest standard scores than the eutrophic ones (p = 0.01), but similar Object Control subtest and Gross Motor Quotient scores (p > 0.05). Excess body fat mass explained 12% of the low Locomotor subtest standard scores in preschoolers (R² = 0.12; p = 0.007). Excess body fat mass was associated with worse locomotor skills when the model was adjusted for physical activity levels, age, socioeconomic status, maternal education, quality of the home environment and quality of the school environment. Thus, excess body fat mass partly explains lower locomotor skills in preschoolers.

Physical environmental opportunities for active play and physical activity level in preschoolers: a multicriteria analysis

Background

Active play opportunities seems to influence the level of physical activity during childhood. However, a gap remains about which environmental opportunities including the daycare physical environment could have a positive impact on the level of physical activity in preschoolers.

Objectives

(1) To develop an index to measure the environmental opportunities of free active play for preschoolers of middle-income countries; (2) to check the relationship and contribution of the index to explain objectively the level of physical activity.

Methods

A quantitative, cross-sectional, exploratory study with 51 preschool children. The established criteria for the index according to the literature were: (1) Outdoor time on typical days of the week. (2) Outdoor time on a typical weekend day. (3) The presence of internal space and external environment in the child’s home that allows playing. (4) Presence of patio with space for games at the school. (5) Presence of a playground with a toy at the school. We applied multi-attribute utility theory for the determination of the multicriteria index of physical environmental opportunities. Pearson’s correlation analysis and simple linear regression were used to verify the association between the index and the physical activity level.

Results

The index showed a positive correlation with the level of physical activity, e.g., the average time of MVPA (r = 0.408, p = 0.003). The univariate linear regression demonstrated that the quality of physical environmental opportunities for physical activity explained 20% of the preschooler’s classification as active and 16% of the time in moderate to vigorous physical activity (p < 0.001).

Conclusion

Physical environmental opportunities for active play have a positive effect on physical activity in preschoolers and should be encouraged in different social segments.