How Economic Downturns Affect Children's Development: An Interdisciplinary Perspective on Pathways of Influence

The Trauma of Separation: Lifelong Health Implications on Children

In the United States, there are millions of globally displaced children who travel with family to seek immigration relief, many of whom have experienced family separation or live under the constant threat of separation. Family separation constitutes a significant trauma with lifelong impacts on a child's mental health, physical health, and development. This review provides a summary of the various contexts within which family separation occurs as well as the current literature on long-term health sequelae. These include mental illness, externalizing behaviors, developmental challenges, family stability, economic impacts, and educational attainment. Given the number of newcomer children in the US, it is paramount that pediatric clinicians develop a holistic understanding of their needs and the effects of separation to provide evidence-based care and to advocate for the prevention of this trauma for all future migrant families. [Pediatr Ann. 2024;53(5):e167-e170.].

Annual Research Review: Sex, gender, and internalizing conditions among adolescents in the 21st century - trends, causes, consequences

Internalizing conditions of psychopathology include depressive and anxiety disorders; they most often onset in adolescence, are relatively common, and contribute to significant population morbidity and mortality. In this research review, we present the evidence that internalizing conditions, including depression and anxiety, as well as psychological distress, suicidal thoughts and self-harm, and fatal suicide, are considerably increasing in adolescent populations across many countries. Evidence indicates that increases are currently greatest in female adolescents. We present an epidemiological framework for evaluating the causes of these increases, and synthesize research on whether several established risk factors (e.g., age of pubertal transition and stressful life events) and novel risk factors (e.g., digital technology and social media) meet conditions necessary to be plausible causes of increases in adolescent internalizing conditions. We conclude that there are a multitude of potential causes of increases in adolescent internalizing conditions, outline evidence gaps including the lack of research on nonbinary and gender nonconforming populations, and recommend necessary prevention and intervention foci from a clinical and public health perspective.

Developmental delay and its demographic and social predictors among preschool-age children in Palestine

PURPOSE

This study was designed to assess the developmental outcomes among preschool-aged children and its associated factors in Palestine.

METHODS

A cross-sectional, descriptive-correlational design involved a representative sample of preschool-aged children from kindergarten in Ramallah governorate. Data were collected using the Ages and Stages Questionnaire, Arabic version-3. Associations between developmental delay (DD), parent, child and family characteristics were analyzed utilizing SPSS-25 version.

RESULTS

A total of 249 preschoolers participated in the study. The overall rate of children with Global Developmental Delay (GDD) was 23.7%. The most prevalent DD were in gross motor, personal social, and fine motor skills (25.3%, 17.7%, and 16.5%, respectively). Binary logistic regression analysis revealed that the male gender of a child (OR = 2.66, 95% CI [1.37, 5.19]), the mother's part-time work (OR = 6.01, 95% CI [1.68, 21.52]), low family income (OR = 3.67, 95% CI [1.05, 12.73]), and families with three or more children (OR = 1.43, 95% CI [1.15, 1.781]) were statistically significant independent predictors of GDD.

CONCLUSION

The study findings revealed higher rate of DD among preschoolers in Palestine than regional areas, especially in gross motor, fine motor, and personal social skills, which has consequences for both national and global health. According to the results, factors related to the child, the mother and the family are associated with the cumulative risk of preschoolers having DD.

IMPLICATIONS

It is a crucial role for pediatric nurses to detect DD early and its related risk factors through screening programs to limit the burden of problems in childhood and later adulthood.

Supporting child and family resilience in the face of political violence: Evidence from a home visit parenting program

Political violence affects more than 25% of children globally, yet little is known about how to support positive adaptation among conflict-affected children. Using a sample of 3797 Nicaraguan child-caregiver dyads (MAgeTime1  = 1.5 years, MAgeTime2  = 5.9 years; 51% male), this registered report used a novel quasi-experimental approach to examine how exposure to political violence relates to child and caregiver outcomes, and to test three policy-relevant moderators: participation in a large-scale home visit parenting program, household economic disruption, and media exposure. Results revealed positive associations between political violence and harsh discipline practices (0.33 SD), but there was no evidence that political violence affected children's behavior, caregiver depressive symptoms, or responsive parenting practices, and there was no evidence of moderation.

Economic Hardship and Violence: A Comparison of County-Level Economic Measures in the Prediction of Violence-Related Injury

Economic hardship may lead to a wide range of negative outcomes, including violence. However, existing literature on economic hardship and violence is limited by reliance on official reports of violence and conflation of different measures of economic hardship. The goals of this study are to measure how violence-related injuries are associated with five measures of county-level economic shocks: unemployment rate, male mass layoffs, female mass layoffs, foreclosure rate, and unemployment rate change, measured cross-sectionally and by a 1-year lag. This study measures three subtypes of violence outcomes (child abuse, elder abuse, and intimate partner violence). Yearly county-level data were obtained on violence-related injuries and economic measures from 2005 to 2012 for all 87 counties in Minnesota. Negative binomial models were run regressing the case counts of each violence outcome at the county-year level on each economic indicator modeled individually, with population denominator offsets to yield incidence rate ratios. Crude models were run first, then county-level socio-demographic variables and year were added to each model, and finally fully-adjusted models were run including all socio-demographic variables plus all economic indicators simultaneously. In the fully-adjusted models, a county's higher foreclosure rate is the strongest and most consistently associated with an increase in all violence subtypes. Unemployment rate is the second strongest and most consistent economic risk factor for all violence subtypes. Lastly, there appears to be an impact of gender specific to economic impacts on child abuse; specifically, male mass-lay-offs were associated with increased rates while female mass-lay-offs were associated with decreased rates. Understanding the associations of different types of economic hardship with a range of violence outcomes can aid in developing more holistic prevention and intervention efforts.

Industrial automation and intergenerational income mobility in the United States

This article examines how the automation of jobs has shaped spatial patterns of intergenerational income mobility in the United States over the past three decades. Using data on the spread of industrial robots across 722 local labor markets, we find significantly lower rates of upward mobility in areas more exposed to automation. The erosion of mobility chances is rooted in childhood environments and is particularly evident among males growing up in low-income households. These findings reveal how recent technological advances have contributed to the unequal patterns of economic opportunity in the United States today.

Emotional distress in young adults during the COVID-19 pandemic: evidence of risk and resilience from a longitudinal cohort study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic and associated lockdown could be considered a 'perfect storm' for increases in emotional distress. Such increases can only be identified by studies that use data collected before and during the pandemic. Longitudinal data are also needed to examine (1) the roles of previous distress and stressors in emotional distress during the pandemic and (2) how COVID-19-related stressors and coping strategies are associated with emotional distress when pre-pandemic distress is accounted for.

METHODS

Data came from a cohort study (N = 768). Emotional distress (perceived stress, internalizing symptoms, and anger), COVID-19-related stressors, and coping strategies were measured during the pandemic/lockdown when participants were aged 22. Previous distress and stressors were measured before COVID-19 (at age 20).

RESULTS

On average, participants showed increased levels of perceived stress and anger (but not internalizing symptoms) during the pandemic compared to before. Pre-COVID-19 emotional distress was the strongest predictor of during-pandemic emotional distress, followed by during-pandemic economic and psychosocial stressors (e.g. lifestyle and economic disruptions) and hopelessness, and pre-pandemic social stressors (e.g. bullying victimization and stressful life events). Most health risks to self or loved ones due to COVID-19 were not uniquely associated with emotional distress in final models. Coping strategies associated with reduced distress included keeping a daily routine, physical activity, and positive reappraisal/reframing.

CONCLUSIONS

In our community sample, pre-pandemic distress, secondary consequences of the pandemic (e.g. lifestyle and economic disruptions), and pre-pandemic social stressors were more consistently associated with young adults' emotional distress than COVID-19-related health risk exposures.

Learning loss due to school closures during the COVID-19 pandemic

Suspension of face-to-face instruction in schools during the COVID-19 pandemic has led to concerns about consequences for students' learning. So far, data to study this question have been limited. Here we evaluate the effect of school closures on primary school performance using exceptionally rich data from The Netherlands (n ≈ 350,000). We use the fact that national examinations took place before and after lockdown and compare progress during this period to the same period in the 3 previous years. The Netherlands underwent only a relatively short lockdown (8 wk) and features an equitable system of school funding and the world's highest rate of broadband access. Still, our results reveal a learning loss of about 3 percentile points or 0.08 standard deviations. The effect is equivalent to one-fifth of a school year, the same period that schools remained closed. Losses are up to 60% larger among students from less-educated homes, confirming worries about the uneven toll of the pandemic on children and families. Investigating mechanisms, we find that most of the effect reflects the cumulative impact of knowledge learned rather than transitory influences on the day of testing. Results remain robust when balancing on the estimated propensity of treatment and using maximum-entropy weights or with fixed-effects specifications that compare students within the same school and family. The findings imply that students made little or no progress while learning from home and suggest losses even larger in countries with weaker infrastructure or longer school closures.

Learning loss due to school closures during the COVID-19 pandemic

School closures have been a common tool in the battle against COVID-19. Yet, their costs and benefits remain insufficiently known. We use a natural experiment that occurred as national examinations in The Netherlands took place before and after lockdown to evaluate the impact of school closures on students’ learning. The Netherlands is interesting as a “best-case” scenario, with a short lockdown, equitable school funding, and world-leading rates of broadband access. Despite favorable conditions, we find that students made little or no progress while learning from home. Learning loss was most pronounced among students from disadvantaged homes.

Suspension of face-to-face instruction in schools during the COVID-19 pandemic has led to concerns about consequences for students’ learning. So far, data to study this question have been limited. Here we evaluate the effect of school closures on primary school performance using exceptionally rich data from The Netherlands (n≈ 350,000). We use the fact that national examinations took place before and after lockdown and compare progress during this period to the same period in the 3 previous years. The Netherlands underwent only a relatively short lockdown (8 wk) and features an equitable system of school funding and the world’s highest rate of broadband access. Still, our results reveal a learning loss of about 3 percentile points or 0.08 standard deviations. The effect is equivalent to one-fifth of a school year, the same period that schools remained closed. Losses are up to 60% larger among students from less-educated homes, confirming worries about the uneven toll of the pandemic on children and families. Investigating mechanisms, we find that most of the effect reflects the cumulative impact of knowledge learned rather than transitory influences on the day of testing. Results remain robust when balancing on the estimated propensity of treatment and using maximum-entropy weights or with fixed-effects specifications that compare students within the same school and family. The findings imply that students made little or no progress while learning from home and suggest losses even larger in countries with weaker infrastructure or longer school closures.

COVID-19 and Parent-Child Psychological Well-being

BACKGROUND AND OBJECTIVES

The outbreak of coronavirus disease 2019 has changed American society in ways that are difficult to capture in a timely manner. With this study, we take advantage of daily survey data collected before and after the crisis started to investigate the hypothesis that the crisis has worsened parents' and children's psychological well-being. We also examine the extent of crisis-related hardships and evaluate the hypothesis that the accumulation of hardships will be associated with parent and child psychological well-being.

METHODS

Daily survey data were collected between February 20 and April 27, 2020, from hourly service workers with a young child (aged 2-7) in a large US city (N = 8222 person-days from 645 individuals). A subsample completed a one-time survey about the effects of the crisis fielded between March 23 and April 26 (subsample n = 561).

RESULTS

Ordered probit models revealed that the frequency of parent-reported daily negative mood increased significantly since the start of the crisis. Many families have experienced hardships during the crisis, including job loss, income loss, caregiving burden, and illness. Both parents' and children's well-being in the postcrisis period was strongly associated with the number of crisis-related hardships that the family experienced.

CONCLUSIONS

Consistent with our hypotheses, in families that have experienced multiple hardships related to the coronavirus disease 2019 crisis, both parents' and children's mental health is worse. As the crisis continues to unfold, pediatricians should screen for mental health, with particular attention to children whose families are especially vulnerable to economic and disease aspects of the crisis.

Does Despair Really Kill? A Roadmap for an Evidence-Based Answer

Two seemingly associated demographic trends have generated considerable interest: income stagnation and rising premature mortality from suicides, drug poisoning, and alcoholic liver disease among US non-Hispanic Whites with low education. Economists interpret these population-level trends to indicate that despair induced by financial stressors is a shared pathway to these causes of death. Although we now have the catchy term "deaths of despair," we have yet to study its central empirical claim: that conceptually defined and empirically assessed "despair" is indeed a common pathway to several causes of death. At the level of the person, despair consists of cognitive, emotional, behavioral, and biological domains. Despair can also permeate social relationships, networks, institutions, and communities. Extant longitudinal data sets feature repeated measures of despair-before, during, and after the Great Recession-offering resources to test the role that despair induced by economic decline plays in premature morbidity and mortality. Such tests must also focus on protective factors that could shield individuals. Deaths of despair is more than a phrase; it constitutes a hypothesis that deserves conceptual mapping and empirical study with longitudinal, multilevel data.

Getting Under the Skin: Children's Health Disparities as Embodiment of Social Class

Social class gradients in children's health and development are ubiquitous across time and geography. The authors develop a conceptual framework relating three actions of class-material allocation, salient group identity, and inter-group conflict-to the reproduction of class-based disparities in child health. A core proposition is that the actions of class stratification create variation in children's mesosystems and microsystems in distinct locations in the ecology of everyday life. Variation in mesosystems (e.g., health care, neighborhoods) and microsystems (e.g., family structure, housing) become manifest in a wide variety of specific experiences and environments that produce the behavioral and biological antecedents to health and disease among children. The framework is explored via a review of theoretical and empirical contributions from multiple disciplines and high-priority areas for future research are highlighted.

Local Job Losses and Child Maltreatment: The Importance of Community Context

A growing body of literature suggests that economic downturns predict an increase in child maltreatment. However, to inform policies and practices to prevent and intervene in child maltreatment, it is necessary to identify how, when, and under what conditions community-level economic conditions affect child maltreatment. In this study, we use North Carolina administrative data from 2006 to 2011 on child maltreatment reports and job losses to distinguish effects on maltreatment frequency from effects on severity, identify the timing of these effects, and test whether community characteristics moderate these effects. To isolate effects of unanticipated job losses and to control for potential confounding factors, we use a fixed effects regression approach. We find that, though job losses did not affect the frequency of reports, job losses increased the share of reports that were relatively severe. This effect endured for 9 months following job losses and was only evident in economically disadvantaged communities.

They Should Say "I Don't": Norms About Midpregnancy Marriage and Job Loss

This study examined effects of local economic conditions on individuals' attitudes toward midpregnancy marriages using an experimental vignette method. Adults (N = 460) were each shown two vignettes about a hypothetical couple expecting a baby; within each vignette pair, vignettes randomly varied as to whether the couple lived in a community that had recently experienced job losses or had stable employment. Respondents indicated if the couple should and will get married before the baby's birth. Results showed that worse local economic conditions led people to believe that marriage would be less common. Among more socio-economically disadvantaged respondents, if the hypothetical couple lived in a community with job loss, fewer respondents also thought that the couple should marry. In contrast, among more socioeconomically advantaged respondents, slightly more respondents thought that the couple should marry. When economic conditions worsen, low-socioeconomic-status individuals may believe that financial prerequisites for marriage become harder to meet.

The Great Recession and risk for child abuse and neglect

This paper examines the association between the Great Recession and four measures of the risk for maternal child abuse and neglect: (1) maternal physical aggression; (2) maternal psychological aggression; (3) physical neglect by mothers; and (4) supervisory/exposure neglect by mothers. It draws on rich longitudinal data from the Fragile Families and Child Wellbeing Study, a longitudinal birth cohort study of families in 20 U.S. cities (N = 3,177; 50% African American, 25% Hispanic; 22% non-Hispanic white; 3% other). The study collected information for the 9-year follow-up survey before, during, and after the Great Recession (2007-2010). Interview dates were linked to two macroeconomic measures of the Great Recession: the national Consumer Sentiment Index and the local unemployment rate. Also included are a wide range of socio-demographic controls, as well as city fixed effects and controls for prior parenting. Results indicate that the Great Recession was associated with increased risk of child abuse but decreased risk of child neglect. Households with social fathers present may have been particularly adversely affected. Results also indicate that economic uncertainty during the Great Recession, as measured by the Consumer Sentiment Index and the unemployment rate, had direct effects on the risk of abuse or neglect, which were not mediated by individual-level measures of economic hardship or poor mental health.

The Kids are All Right? Income Inequality and Civic Engagement among Our Nation's Youth

Prior work suggests that income inequality depresses civic participation among adults. However, associations between income inequality and youth civic engagement have not been assessed. This is true despite evidence that other features of communities influence youth civic development. To fill the gap, we examine associations between county-level income inequality and civic engagement among a nationally representative sample of 12,240 15-year-olds (50 % female). We find opposite patterns than those suggested by the adult literature. Higher county-level income inequality is associated with slightly more civic engagement (greater importance of helping others, higher rates of volunteering often), and this is particularly true for low-socioeconomic status and racial/ethnic minority youth. Potential developmental and structural explanations for these differences are offered. In addition, practical implications of these findings are drawn, and future research directions for scholars studying youth are proposed.

The impact of changing economic conditions on overweight risk among children in California from 2008 to 2012

BACKGROUND

The recent economic recession represents an opportunity to test whether decreases in economic resources may have deleterious consequences on childhood overweight/obesity risk.

METHODS

We investigated the association between indicators of changing macroeconomic conditions from 2008 to 2012 and overweight/obesity risk among school-aged children in California (n=1 741 712) using longitudinal anthropometric measurements. Multivariate regression, with individual and county fixed effects, was used to examine the effects of annual county-level unemployment and foreclosure rates on risk of child overweight/obesity, overall and among subgroups (race/ethnicity, sex, county-level median household income and county-level urban/rural status).

RESULTS

From 2008 to 2012, ∼38% of children were overweight/obese and unemployment and foreclosure rates averaged 11% and 6.9%, respectively. A 1-percentage point (pp) increase in unemployment was associated with a 1.4 pp (95% CI 1.3 to 1.5) increase in overweight/obesity risk. Therefore, a child of average weight could expect a 14% increase in their body mass index z-score in association with a 1 pp increase in unemployment during the study period. We found some differences in the magnitude of the effects for unemployment among demographic subgroups, with the largest effects observed for unemployment among American Indians and Pacific Islanders.

CONCLUSIONS

Comparing children to themselves over time, we provide evidence that increases in county-level unemployment are associated with increased overweight/obesity risk. Given that overweight among children with lower economic resources remains a challenge for public health, these findings highlight the importance of policy-level approaches, which aim to mitigate the impact of decreased resources as economic conditions change.