Evaluation of a Longitudinal Family Stress Model in a Population-Based Cohort

The impact of poverty and socioeconomic status on brain, behaviour, and development: a unified framework

In this article, we, for the first time, provide a comprehensive overview and unified framework of the impact of poverty and low socioeconomic status (SES) on the brain and behaviour. While there are many studies on the impact of low SES on the brain (including cortex, hippocampus, amygdala, and even neurotransmitters) and behaviours (including educational attainment, language development, development of psychopathological disorders), prior studies did not integrate behavioural, educational, and neural findings in one framework. Here, we argue that the impact of poverty and low SES on the brain and behaviour are interrelated. Specifically, based on prior studies, due to a lack of resources, poverty and low SES are associated with poor nutrition, high levels of stress in caregivers and their children, and exposure to socio-environmental hazards. These psychological and physical injuries impact the normal development of several brain areas and neurotransmitters. Impaired functioning of the amygdala can lead to the development of psychopathological disorders, while impaired hippocampus and cortex functions are associated with a delay in learning and language development as well as poor academic performance. This in turn perpetuates poverty in children, leading to a vicious cycle of poverty and psychological/physical impairments. In addition to providing economic aid to economically disadvantaged families, interventions should aim to tackle neural abnormalities caused by poverty and low SES in early childhood. Importantly, acknowledging brain abnormalities due to poverty in early childhood can help increase economic equity. In the current study, we provide a comprehensive list of future studies to help understand the impact of poverty on the brain.

The influence of socio-economic status on child temperament and psychological symptom profiles

The influence of socio-economic status (SES) on child temperament and psychological symptoms was examined using a nationally representative sample in Singapore. Data were available for 2169 children from 1987 families. Caregivers' reports were obtained on children aged 4-6. SES was operationalized as an aggregation of household income per capita, parental education level and housing type. Compared to their counterparts from higher SES families, children from low-SES families tended to exhibit (a) higher negative affectivity but lower effortful control, and (b) higher internalizing and externalizing symptoms. In addition, children with a 'resilient' temperamental profile (i.e. low negative affectivity and high effortful control) were more likely to come from families with much higher SES, relative to children with other profiles. Children with high internalizing symptoms tended to come from low-SES backgrounds, regardless of their externalizing symptoms. Among children with low internalizing symptoms, those with high externalizing symptoms came from lower SES backgrounds compared to those with low externalizing symptoms. Parental warmth and distress mediated the association between SES and child temperament and symptom profiles, with the exception of distress in the SES-temperament link. These findings supported the family stress model and highlighted the novel perspective of SES's influence on configurations of child temperament and symptom characteristics.

Investigating the Poverty-Reducing Effects of SNAP on Non-nutritional Family Outcomes: A Scoping Review

INTRODUCTION/PURPOSE

Poverty-reduction efforts that seek to support households with children and enable healthy family functioning are vital to produce positive economic, health, developmental, and upward mobility outcomes. The Supplemental Nutrition Assistance Program (SNAP) is an effective poverty-reduction policy for individuals and families. This study investigated the non-nutritional effects that families experience when receiving SNAP benefits.

METHODS

We conducted a scoping review using the PRISMA Guidelines and strategic search terms across seven databases from 01 January 2008 to 01 February 2023 (n=2456). Data extraction involved two researchers performing title-abstract reviews. Full-text articles were assessed for eligibility (n=103). Forty articles were included for data retrieval.

RESULTS

SNAP positively impacts family health across the five categories of the Family Stress Model (Healthcare utilization for children and parents, Familial allocation of resources, Impact on child development and behavior, Mental health, and Abuse or neglect).

DISCUSSION/CONCLUSION

SNAP is a highly effective program with growing evidence that it positively impacts family health and alleviates poverty. Four priority policy actions are discussed to overcome the unintentional barriers for SNAP: distributing benefits more than once a month; increasing SNAP benefits for recipients; softening the abrupt end of benefits when wages increase; and coordinating SNAP eligibility and enrollment with other programs.

A prospective study of financial worry, mental health changes and the moderating effect of social support among Canadian adolescents during the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic intensified the impact of risk factors for adolescent mental health, including financial worry. Social support has shown to protect from negative mental health during times of stress. We examined the effect of financial worry on changes in anxiety and depression symptoms among Canadian adolescents prior to and during the pandemic, and assessed whether social support from family and friends moderated any changes.

METHODS

We analyzed 2-year linked data from the 2018/19 (pre-pandemic) and 2020/21 (during-pandemic) waves of the COMPASS study, with reports from 12 995 Canadian secondary school students. A series of multilevel linear regressions were conducted to examine the main hypotheses under study.

RESULTS

Students scored an average (SD) of 7.2 (5.8) on the anxiety (GAD-7) and 10.0 (6.5) on the depression (CESD-10) scales; 16.1% reported they experienced financial worry during the pandemic. Financial worry was a strong and significant predictor of increased anxiety scores (+1.7 score between those reporting "true/mostly true" versus "false/mostly false") during the pandemic, but not for depression scores. Low family and friend support were associated with anxiety, and low family support was associated with depression. No significant interactions were detected between social support and financial worry.

CONCLUSIONS

Pandemic-related financial worry was significantly associated with anxiety in our large sample of Canadian adolescents. Clinical and public health initiatives should be aware of adolescents' financial worry and its associations with anxiety during times of crisis.

The Relation Between Adverse Childhood Experiences and Health Behaviors in Adult Women

PURPOSE

This study aims to identify whether adverse childhood experiences (ACEs) influence health lifestyles throughout adulthood and examine how ACEs influence dimensions of health lifestyles.

DESIGN

The data was collected cross-sectionally through an online questionnaire.

SETTING

Individuals were invited to participate in an online survey for a larger brain health study as a pre-screening measure.

SUBJECTS

Women in the Midwest between 18-25 and 65-85 who reported either no ACEs or 3 or more ACEs completed the survey, with 233 women answering all questionnaires.

MEASURES

Demographic indicators, the 10-item ACEs questionnaire, and the Health Promoting Lifestyle Profile (HPLP-II).

ANALYSIS

Independent sample t-tests revealed significantly lower scores for ACEs group on the HPLP-II and the 6 subcategories (heath responsibility, interpersonal relationships, nutrition, physical activity, spiritual growth, and stress management). A structural equation model using the 3 ACE categories (abuse, neglect, and household dysfunction) and 6 health domains showed substantial differences in the variance captured for each health behavior.

RESULTS

Findings indicate that abuse predicts physical activity, stress management, and spiritual growth (β = -.21, -.23, -.20); neglect predicts interpersonal relationships and spiritual growth (β = -.17, -.18); and household dysfunction predicts health responsibility, nutrition, stress management, and interpersonal relations (β = -.20, -.22, -.10, -.17).

CONCLUSION

The present investigation extends research in displaying that ACEs play a significant role in future health behaviors, with household dysfunction being the greatest predictor.

Engaging Parents in Technology-Assisted Interventions for Childhood Adversity: Systematic Review

BACKGROUND

Youth mental health problems are a major public health concern and are strongly associated with adverse childhood experiences (ACEs). Technology-assisted parenting programs can intervene with ACEs that are within a parent's capacity to modify. However, engagement with such programs is suboptimal.

OBJECTIVE

This review aims to describe and appraise the efficacy of strategies used to engage parents in technology-assisted parenting programs targeting ACEs on the behavioral and subjective outcomes of engagement.

METHODS

Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines, we conducted a systematic review of peer-reviewed papers that described the use of at least 1 engagement strategy in a technology-assisted parenting program targeting ACEs that are within a parent's capacity to modify. A total of 8 interdisciplinary bibliographic databases (CENTRAL, CINAHL, Embase, OVID MEDLINE, OVID PsycINFO, Scopus, ACM, and IEEE Xplore) and gray literature were searched. The use of engagement strategies and measures was narratively synthesized. Associations between specific engagement strategies and engagement outcomes were quantitatively synthesized using the Stouffer method of combining P values.

RESULTS

We identified 13,973 articles for screening. Of these, 156 (1.12%) articles were eligible for inclusion, and 29 (18.2%) of the 156 were associated with another article; thus, 127 studies were analyzed. Preliminary evidence for a reliable association between 5 engagement strategies (involving parents in a program's design, delivering a program on the web compared to face-to-face, use of personalization or tailoring features, user control features, and provision of practical support) and greater engagement was found. Three engagement strategies (professional support features, use of videos, and behavior change techniques) were not found to have a reliable association with engagement outcomes.

CONCLUSIONS

This review provides a comprehensive assessment and description of the use of engagement strategies and engagement measures in technology-assisted parenting programs targeting parenting-related ACEs and extends the current evidence with preliminary quantitative findings. Heterogeneous definition and measurement of engagement and insufficient engagement outcome data were caveats to this synthesis. Future research could use integrated definitions and measures of engagement to support robust systematic evaluations of engagement in this context.

TRIAL REGISTRATION

PROSPERO CRD42020209819; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209819.

Economic hardship and adolescent behavioral outcomes: Within- and between-family associations

Understanding how youth perceive household economic hardship and how it relates to their behavior is vital given associations between hardship and behavioral development. Yet, most studies ignore youth's own perceptions of economic hardship, instead relying solely on caregiver reports. Moreover, the literature has tended to treat economic hardship as a stable force over time, rather than a volatile one that varies month-to-month. This study addressed extant limitations by collecting monthly measures of economic hardship, specifically caregiver- and youth-reported material deprivation and youth-reported financial stress, and youth internalizing and externalizing problems from 104 youth-caregiver dyads (youth: 14-16 years, 55% female, 37% Black, 43% White) over nine months. We examined month-to-month variability of these constructs and how youth-reports of material deprivation and financial stress predicted their behavior problems, controlling for caregiver-reports of material deprivation. We found that hardship measures varied month-to-month (ICCs = 0.69-0.73), and youth-reported material deprivation positively predicted internalizing when examining both within- and between-individual variability (β = .19-.47). Youth-reported financial stress positively predicted within-individual variation in externalizing (β = .18), while youth reports of material deprivation predicted externalizing when looking between families (β = .41). Caregiver-reported material deprivation was unrelated to youth behavior when accounting for youth perceptions of economic hardship.

Effect of a Financial Education and Coaching Program for Low-Income, Single Mother Households on Child Health Outcomes

The financial difficulties of parents have a negative impact on the health of their children. This problem is more pronounced in single mother families. There is limited research on low-income, single mothers and how interventions to help them address financial difficulties may also benefit their children. The purpose of this study was to evaluate the effect of a year-long financial education and coaching program on school absenteeism and health care utilization of children in employed, low-income, single mother households. This was a post hoc analysis of the Finances First study, a randomized controlled trial conducted in 2017-2020 examining the impact of a financial coaching and education program on economic stability and health outcomes in 345 low-income, single mothers. Either generalized estimating equations (GEEs) or generalized linear mixed models (GLMMs) were used to account for relationships between participants. For the continuous outcomes of child absenteeism, physician visits, emergency room visits, and hospitalization days, a linear mixed-effects model was used. The Finances First study demonstrated improvements in various financial strain measures. Compared to the control group, children of intervention group participants experienced 1 fewer day of school absence (p = 0.049) and 1 fewer physician visit (p = 0.032) per year, but no impact was seen on emergency room visits (p = 0.55) or hospitalizations (p = 0.92). Addressing social determinants of health in parents is necessary for improving child health outcomes.

Household income supplements in early childhood to reduce inequities in children's development

BACKGROUND

Early childhood interventions have the potential to reduce children's developmental inequities. We aimed to estimate the extent to which household income supplements for lower-income families in early childhood could close the gap in children's developmental outcomes and parental mental health.

METHODS

Data were drawn from a nationally representative birth cohort, the Longitudinal Study of Australian Children (N = 5107), which commenced in 2004 and conducted follow-ups every two years. Exposure was annual household income (0-1 year). Outcomes were children's developmental outcomes, specifically social-emotional, physical functioning, and learning (bottom 15% versus top 85%) at 4-5 years, and an intermediate outcome, parental mental health (poor versus good) at 2-3 years. We modelled hypothetical interventions that provided a fixed-income supplement to lower-income families with a child aged 0-1 year. Considering varying eligibility scenarios and amounts motivated by actual policies in the Australian context, we estimated the risk of poor outcomes for eligible families under no intervention and the hypothetical intervention using marginal structural models. The reduction in risk under intervention relative to no intervention was estimated.

RESULTS

A single hypothetical supplement of AU$26,000 (equivalent to ∼USD$17,350) provided to lower-income families (below AU$56,137 (∼USD$37,915) per annum) in a child's first year of life demonstrated an absolute reduction of 2.7%, 1.9% and 2.6% in the risk of poor social-emotional, physical functioning and learning outcomes in children, respectively (equivalent to relative reductions of 12%, 10% and 11%, respectively). The absolute reduction in risk of poor mental health in eligible parents was 1.0%, equivalent to a relative reduction of 7%. Benefits were similar across other income thresholds used to assess eligibility (range, AU$73,329-$99,864).

CONCLUSIONS

Household income supplements provided to lower-income families may benefit children's development and parental mental health. This intervention should be considered within a social-ecological approach by stacking complementary interventions to eliminate developmental inequities.

Can you See What We See? African American Parents' Views of the Strengths and Challenges of Children and Youth Living with Adversity

A premise of positive youth development is that social competencies can develop in adversity and co-exist with problem behaviors. This research tested whether African American youth ages 9-17 who had experienced significant family stressors would form groups that displayed combinations of adversity, problem behavior, and strengths. Parents of a nationally representative sample of African Americans children were interviewed on child difficulties and strengths as part of the CDC's 2019 National Health Interview Survey. About 15% of the national sample of African American youth had experienced violence or parental incarceration, depression, or drug abuse. Latent class analysis (LCA) using indicators of adversity and strengths identified four distinct classes. Class 1 included youth who experienced multiple adversities, exhibited few strengths, and were high in behavior problems. Members of both classes 2 and 3 were more likely to experience parental incarceration but exhibited altruism. Class 3 also experienced parental mental health problems. Members of class 4 had the highest exposure to violence but were comparatively high in altruism and affability. Regression analysis revealed that the groups differed from one another on emotional health but not on physical health controlling for age and gender. These findings support a focus by mental health prevention programs on building on the strengths of children growing up in adversity.

Mindfulness Intervention Improves Coping and Perceptions of Children's Behavior among Families with Elevated Risk

Mindfulness-informed interventions (MIIs) are increasingly common but have not been extensively studied among families with elevated levels of risk (e.g., those involved in child protective services and/or receiving financial assistance). These families often experience high rates of stressors that can impact coping strategies, interpersonal dynamics, and relationships. Given that mindfulness has been shown to promote health and wellbeing, this study used a sample from two pilot randomized controlled trials to test the extent to which a mindfulness-informed intervention improved coping strategies and perceptions of children's behavior among 53 families with elevated risk. A principal components analysis with a direct oblimin rotation revealed that cognitive-emotion coping strategies could be characterized by three factors: positive adaptation, negative adaptation, and positive refocusing. Intention-to-treat analysis indicated significant group by time differences, with intervention participants demonstrating improvements in positive refocusing coping, positive adaptation coping, and perceptions of children's behavior problems compared to participants in the waitlist control group. No significant differences were found for negative adaptation coping strategies. Findings provide preliminary support for the benefits of mindfulness training in a sample generally underrepresented in the mindfulness intervention literature.

Disentangling Poverty From Neglect: Using a Person-Centered Approach to Examine Risk Factors for Neglect Among Families in Poverty

Approximately 18% of U.S. children under 5 years old live in poverty, which is one of the strongest predictors of child neglect. However, most families in poverty do not engage in neglect and this may be due to heterogeneity in risk factors. This study examined how risk factors co-occurred among families in poverty across early childhood and whether risk profiles were differentially related to physical and supervisory neglect across time. Results suggested there were four risk profiles across early childhood (i.e., years 1 and 3). At year 1, the four profiles in order of prevalence were: Low Risk, High Risk, Depressed and Uninsured, and Stressed with Health Problems. At year 3, the profiles were: Low Risk, High Risk, Depressed with Residential Instability, and Stressed with Health Problems. Overall, the High Risk profile was associated with more physical and supervisory neglect across time compared to the Low Risk profile; however, the Stress with Health Problems profile was also associated with greater physical neglect. These findings illustrate heterogeneity in the risk factors among families in poverty and demonstrate the differential impact of risk exposure on later neglect. Results also provide evidence to practitioners and policymakers about target risk experiences to prevent neglect.

The impact of poverty-reduction intervention on child mental health mediated by family relations: Findings from a cluster-randomized trial in Uganda

Reviews that synthesize global evidence on the impact of poverty reduction interventions on child and adolescent mental health (CAMH) report inconclusive results and highlight the need to unpack the mechanisms that connect poverty-reduction to CAMH. To address this gap, we examine the proposition that family relations is an important relational factor transmitting effect of poverty on CAMH, and test whether family relations mediate the effect of poverty-reduction intervention on depression, hopelessness, and self-concept among AIDS orphans in Uganda. We use longitudinal data collected over the course of 48 months in a cluster-randomized controlled trial conducted among N = 1410 AIDS orphans from n = 48 schools in Uganda. To examine the relationship between intervention, latent mediator (family relations and support) and CAMH outcomes (Beck Hopelessness Scale (BHS), Tennessee Self-Concept Scale (TSCS), and Depression), we ran structural equation models adjusting for clustering of individuals within schools. Relative to the control group, participants in both treatment arms reported lower levels of hopelessness and depression, and significantly higher levels of self-concept. They also report significantly higher levels of latent family relationship in all three models. In both treatment arms, the direct effect of the intervention on all three outcomes is still significant when the latent family relations mediator is included in the analyses. This suggests partial mediation. In other words, in both treatment arms, the significant positive effect of the intervention on children's depression, hopelessness, and self-concept is partially mediated by their family relationship quality. Our findings support the argument put forward by the Family Stress Model showing that the poverty-reduction program improves children's mental health functioning by improving family relationships. The implications of our study extend beyond the narrow focus of poverty reduction, suggesting that asset-building interventions have broader impacts on family dynamics and child mental health.

Examining mechanisms linking economic insecurity to interparental conflict among couples with low income

Objective

The current study used the family stress model to test the mechanisms by which economic insecurity contributes to mothers' and fathers' mental health and couples' relationship functioning.

Background

Although low household income has been a focus of poverty research, material hardship-defined as everyday challenges related to making ends meet including difficulties paying for housing, utilities, food, or medical care-is common among American families.

Methods

Participants were from the Building Strong Families project. Couples were racially diverse (43.52% Black; 28.88% Latinx; 17.29% White; 10.31% Other) and living with low income (N = 2,794). Economic insecurity included income poverty and material hardship. Bayesian mediation analysis was employed, taking advantage of the prior evidence base of the family stress model.

Results

Material hardship, but not income poverty, predicted higher levels of both maternal and paternal depressive symptoms. Only paternal depressive symptoms were linked with higher levels of destructive interparental conflict (i.e., moderate verbal aggression couples use that could be harmful to the partner relationship). Mediation analysis confirmed that material hardship operated primarily through paternal depressive symptoms in its association with destructive interparental conflict.

Conclusion

The economic stress of meeting the daily material needs of the family sets the stage for parental mental health problems that carry over to destructive interparental conflict, especially through paternal depressive symptoms.

Implications

Family-strengthening programs may want to consider interventions to address material hardship (e.g., comprehensive needs assessments, connections to community-based resources, parents' employment training) as part of their efforts to address parental mental health and couples' destructive conflict behaviors.

Risk, Emotional Support, Child Abuse Potential, and Parenting During the First Year of the COVID-19 Pandemic

The COVID-19 pandemic and associated mitigation efforts created stress that threatened parent and child well-being. Conditions that increase stress within families heighten the likelihood of child abuse, but social support can mitigate the impact. This short-term investigation considered whether cumulative risk, COVID-19 specific risk, and emotional support (one aspect of social support), were associated with child abuse potential during the pandemic. Additionally, we investigated whether emotional support moderated the association between COVID-19 specific risk and child abuse potential, and associations between child abuse potential and emotionally positive and emotionally negative parenting. Participants included 89 parents, from a metropolitan area with a large number of economically distressed families, who completed online questionnaires. COVID-19 specific risk and emotional support each explained additional variance in child abuse potential beyond cumulative risk, but emotional support did not moderate the association between COVID-19 specific risk and child abuse potential. Consistent with expectations, child abuse potential was negatively associated with emotionally positive parenting and positively associated with emotionally negative parenting practices. Results highlight the importance of addressing both risks and supports at multiple levels for parents during times of stress.

The Impact of COVID-19 Household Isolation on Conflict and Cohesion in One-, Two-, and Three-Generation Households With Older Adults

The current cross-sectional study examined the effect of coronavirus disease 2019 (COVID-19) household isolation on household conflict and cohesion in one-, two-, and three-generation households with older adults (aged ≥65 years). Participants were 757 adults (aged ≥18 years) with at least one older adult in their household. Respondents were from 51 countries. Study variables were measured with the COVID-19 Household Environmental Scale. Non-parametric tests were used to assess differences between groups. Most participants (n = 437, 57.7%) lived in three-generation homes. Three-generation homes reported greater increases in conflict (p < 0.001) and cohesion (p < 0.001) during household isolation compared to oneand two-generation homes. Findings suggest that older adults living in multigenerational households experienced more cohesive and conflictive household environments as a function of the COVID-19 pandemic. Further research should explore how family or health care interventions could better support older adults and families as a unit of care to avoid adverse outcomes and boost resilience. [Journal of Gerontological Nursing, 49(4), 47-56.].

Neighborhood Poverty, Family Economic Well-Being, and Child Maltreatment

This study sought to understand the relationships between neighborhood poverty, family monetary well-being, and child maltreatment. The specific research questions were as follows: (1) Is neighborhood poverty at age 1 related to child physical abuse, psychological abuse, and neglect at age 5? (2) Are these relationships mediated by family monetary well-being? The study relied on data from three waves (child ages 1, 3, and 5) of the Fragile Families and Child Wellbeing Study, a longitudinal birth-cohort study of 4,898 children from 20 large U.S. cities. Structural equation modeling was employed to examine mediational effects. The study found a lasting impact of neighborhood poverty on child neglect only, and this relationship was fully mediated by family monetary well-being. There was not a significant longitudinal relationship between neighborhood poverty and physical abuse or psychological abuse. Implications from the study suggest that neighborhood disadvantage impacts a families' economic well-being, and that individual-level economic supports may interrupt the pathway from neighborhood poverty to child neglect.

Experiences of Mothers Participating in a Mother-Child Video Therapy Program

INTRODUCTION

Responsive and sensitive parenting promotes the development of self-regulation and lowers stress in children, which in turn is associated with greater educational and economic achievement and better physical and emotional health later in life. Dyadic parent-child video-feedback programs can help parents learn effective parenting skills, yet these programs are estimated to retain only about half of eligible participants. Programs vary widely, and little is known about what is valued by parents who do complete these programs. The purpose of this qualitative study was to understand the goals, experiences, and outcomes important to mothers who completed a video-feedback program.

METHODS

Transcripts of exit interviews of participants in a video-feedback program (N = 31) were analyzed using qualitative description methodology. Trustworthiness was achieved through deep engagement with the material, following an iterative process in analyzing transcripts, and member checks to confirm results.

RESULTS

Mothers enrolled in the program to better understand their child, help their child learn, and to develop closer connections with their child. Elements of the program that helped mothers achieve these goals were (1) positive feedback and support by the therapist, (2) dedicated one-on-one time spent with their infant, (3) help with concrete needs, and (4) learning from watching videotaped play sessions. As a result, mothers reported greater confidence as caregivers, use of more responsive and sensitive parenting strategies, and improvements in their children's behaviors and their own mental health.

DISCUSSION

Incorporating elements of the program found to be most useful in this study into video-feedback programs may make video-feedback programs more attractive to parents and increase retention. Midwives and women's health care providers may incorporate elements of the program into their clinical practice and advocacy, with special attention to elements most valued by parents themselves.

Prospective longitudinal associations between harsh parenting and corticolimbic function during adolescence

Childhood adversity is thought to undermine youth socioemotional development via altered neural function within regions that support emotion processing. These effects are hypothesized to be developmentally specific, with adversity in early childhood sculpting subcortical structures (e.g., amygdala) and adversity during adolescence impacting later-developing structures (e.g., prefrontal cortex; PFC). However, little work has tested these theories directly in humans. Using prospectively collected longitudinal data from the Fragile Families and Child Wellbeing Study (FFCWS) (N = 4,144) and neuroimaging data from a subsample of families recruited in adolescence (N = 162), the current study investigated the trajectory of harsh parenting across childhood (i.e., ages 3 to 9) and how initial levels versus changes in harsh parenting across childhood were associated with corticolimbic activation and connectivity during socioemotional processing. Harsh parenting in early childhood (indexed by the intercept term from a linear growth curve model) was associated with less amygdala, but not PFC, reactivity to angry facial expressions. In contrast, change in harsh parenting across childhood (indexed by the slope term) was associated with less PFC, but not amygdala, activation to angry faces. Increases in, but not initial levels of, harsh parenting were also associated with stronger positive amygdala-PFC connectivity during angry face processing.

Stay-at-Home: The Impact of the COVID-19 Lockdown on Household Functioning and ART Adherence for People Living with HIV in Three Sub-districts of Cape Town, South Africa

In March 2020, the South African government imposed a lockdown to control COVID-19 transmission. Lockdown may affect people living with HIV’s (PLWH) antiretroviral therapy (ART) adherence. Data from a cluster randomised control trial was collected from 152 PLWH in Cape Town sub-districts from October 2019–March 2020 when the lockdown halted collection. Subsequently, 83 PLWH were followed-up in June–July 2020. Random effects models were used to analyse: (1) changes between baseline and follow-up and (2) correlates of adherence during lockdown. At follow-up, there was an increase in the odds of being below the poverty line and the odds of experiencing violence decreased. Measures for well-being, household functioning, stigma and HIV competency improved. Violence, depression, food insecurity, and stigma were associated with poorer ART adherence; higher well-being scores were associated with better adherence. During lockdown, governments need to ensure financial support, access to (mental) health services, and services for those experiencing violence.

Clinical Trial Number: Pan African Clinical Trial Registry, PACTR201906476052236. Registered on 24 June 2019.

The Emergence of 5-Year-Olds' Behavioral Difficulties: Analyzing Risk and Protective Pathways in the United Kingdom and Germany

This study aimed to advance our understanding of 5-year-olds' behavioral difficulties by modeling and testing both mediational protective and risk pathways simultaneously. Drawing on two national samples from different Western European countries-the United Kingdom (13,053) and Germany (2,022), the proposed model considered observed sensitive parental interactive behaviors and tested child vocabulary as protective pathways connecting parental education with children's behavioral outcomes; the risk pathways focused on negative parental disciplinary practices linking (low) parental education, parental distress, and children's difficult temperament to children's behavioral difficulties. Further, the tested model controlled for families' income as well as children's sex and formal child care attendance. Children with comparatively higher educated parents experienced more sensitive interactive behavior, had more advanced vocabulary, and exhibited fewer behavioral difficulties. Children with a comparatively higher level of difficult temperament or with parents who suffered from distress tended to experience more negative disciplinary behavior and exhibited more behavioral difficulties. Additionally, children's vocabulary skills served as a mechanism mediating the association between parental education and children's behavioral difficulties. Overall, we found similar patterns of results across the United Kingdom and Germany with both protective and risk pathways contributing simultaneously to children's behavioral development. The findings suggest that promoting parents' sensitive interactive behaviors, favorable disciplinary practices, and child's vocabulary skills have potential for preventing early behavioral difficulties.

A Preliminary Study of COVID-19-related Stressors, Parenting Stress, and Parental Psychological Well-being Among Parents of School-age Children

The COVID-19 pandemic has had substantial health, social, and economic effects on families. Consequent lockdowns and school closures heightened the burden on parents of school-age children. Many parents, while working from home, had to care for their children with restricted access to caregiver resources and to support their children's education through homeschooling or remote learning provided by their schools. These duties created challenges and pressures on parents. Using online survey data collected from 197 parents of school-age (Prek-12) children during the first three months of the COVID-19 pandemic in the U.S., this preliminary study examined the relations among COVID-19-related stressors, including fear of COVID-19 and problems associated with school closures, parenting stress, and parental psychological well-being. Fear of COVID-19 and various issues associated with school closures were related to parenting stress and parental well-being. Parents with less instrumental and emotional support reported higher levels of parenting stress and lower levels of psychological well-being. The results of hierarchical multiple regressions revealed that parenting stress was the strongest predictor of parental psychological distress. Social support was associated with parental well-being but did not mediate the relation between parenting stress and parental well-being. The findings suggest that parenting stress during the COVID-19 lockdowns might take a toll on the mental health of parents of school-age children. Parents of school-age children need multiple layers of support, including targeted support addressing stressors related to school closures and parenting under quarantine.

Material Hardship in Families With Low Income: Positive Effects of Coparenting on Fathers' and Mothers' Parenting and Children's Prosocial Behaviors

Families with low income experience high levels of economic insecurity, but less is known about how mothers and fathers in such families successfully navigate coparenting and parenting in the context of material hardship. The current study utilized a risk and resilience framework to investigate the underlying family processes linking material hardship and children's prosocial behaviors in a sample of socioeconomically disadvantaged mother-father families with preschoolers from the Building Strong Families project (N = 452). Coparenting alliance and mothers' and fathers' responsive parenting were examined as mediators. Results of structural equation modeling showed that coparenting alliance was associated with higher levels of both mothers' and fathers' responsive parenting. Subsequently, both parents' responsive parenting were associated with higher levels of children's prosocial behaviors. Material hardship was not associated with coparenting alliance and either parent's responsive parenting. Tests of indirect effects confirmed that the effects of coparenting alliance on children's prosocial behaviors were mediated through both mothers' and fathers' responsive parenting. Overall, these results suggest that when mothers and fathers have a strong coparenting alliance, they are likely to withstand the negative effects of material hardship and thus engage in positive parenting behaviors that benefit their children's prosocial development. Family strengthening interventions, including responsible fatherhood programs, would do well to integrate a strong focus on enhancing a positive coparenting alliance between mothers and fathers.

The Impact of Harsh Parenting on the Development of Obesity in Adulthood: An Examination of Epigenetic/Gene Expression Mediators Among African American Youth

Objective: We examined the association of prospectively assessed harsh parenting during adolescence with body mass index (BMI) in young adulthood among African American youth. We also assessed the role of methylation of obesity-related genes and gene expression markers of obesity as mediators of this association, providing a pathway for the biological embedding of early harsh parenting and its long-term impact on young adult health.

Methods: Hypotheses were tested with a sample of 362 African American youth for whom harsh parenting was assessed at ages 10–15, BMI was assessed at age 10 and 29, and both DNA methylation (DNAm) and gene expression of obesity genes were assessed at age 29. Mediational analyses were conducted using bootstrap methods to generate confidence intervals.

Results: Controlling for genetic risk for obesity and health-related covariates, harsh parenting across childhood and adolescence was associated with change in BMI (Δ BMI) from ages 10–29. In addition, we found that the indirect effect of harsh parenting on Δ BMI was mediated through obesity-related DNAm and accounted for 45.3% of the total effect. Further, obesity-related DNAm mediated the effect of harsh parenting on gene expression of obesity-related genes (GEOG), and GEOG, in turn, mediated the impact of obesity-related DNAm on ΔBMI. This pathway accounted for 3.4% of the total effect. There were no gender differences in the magnitude of this indirect effect.

Conclusions: The results suggest that alterations in methylation and gene expression mediate the impact of harsh parenting on change in obesity from childhood to young adulthood, illustrating plausible biological pathways from harsh parenting to obesity and bolstering the hypothesis that harsh parenting in childhood and adolescence can become biologically embedded and contribute to obesity.

Family Functioning in the Time of COVID-19 Among Economically Vulnerable Families: Risks and Protective Factors

The ongoing COVID-19 crisis has been particularly harmful to economically vulnerable families with young children. We surveyed 247 low-income mothers and fathers from 142 families in the United States about changes in their family life following the economic and social restrictions imposed by the pandemic. We examined the associations between pandemic-related risk factors such as economic stressors (e.g., loss of job) and social stressors (e.g., exposure to the virus) on family functioning (e.g., parents' mental health, parent engagement, and children's socioemotional behaviors) and the degree to which coparenting support and parents' positivity protected families from the negative effects of these stressors on their wellbeing. We found both positive and negative associations. Mothers and fathers who reported more economic stressors since the pandemic also observed that their children behaved more prosocially and that fathers experienced more mental health difficulties during the pandemic. Mothers and fathers who reported more social stressors reported that they were less engaged with their children and their children exhibited more behavior problems compared to before the pandemic. We also found that mothers and fathers who reported feeling more positive also reported feeling less depressed and stressed during the pandemic and observed that their children had more prosocial behaviors compared to before the pandemic. Compared to before the pandemic, mothers and fathers who reported a more supportive coparenting relationship also reported more parent engagement and observed more prosocial behaviors in their children. In terms of protective factors, high levels of parent positivity during the pandemic protected mothers (less mental health difficulties) whereas high levels of coparenting support protected fathers (less mental health difficulties) from the negative effects of economic stress on their mental health during the pandemic. These findings highlight family processes that could promote resilience in mothers and fathers in the face of pandemic-related economic and social stressors.

Health Inequalities in Children and Adolescents: A Scoping Review of the Mediating and Moderating Effects of Family Characteristics

This scoping review systematically mapped evidence of the mediating and moderating effects of family characteristics on health inequalities in school-aged children and adolescents (6-18 years) in countries with developed economies in Europe and North America. We conducted a systematic scoping review following the PRISMA extension for Scoping Reviews recommendations. We searched the PubMed, PsycINFO and Scopus databases. Two reviewers independently screened titles, abstracts and full texts. Evidence was synthesized narratively. Of the 12,403 records initially identified, 50 articles were included in the synthesis. The included studies were conducted in the United States (n = 27), Europe (n = 18), Canada (n = 3), or in multiple countries combined (n = 2). We found that mental health was the most frequently assessed health outcome. The included studies reported that different family characteristics mediated or moderated health inequalities. Parental mental health, parenting practices, and parent-child-relationships were most frequently examined, and were found to be important mediating or moderating factors. In addition, family conflict and distress were relevant family characteristics. Future research should integrate additional health outcomes besides mental health, and attempt to integrate the complexity of families. The family characteristics identified in this review represent potential starting points for reducing health inequalities in childhood and adolescence.

Ecological stress, amygdala reactivity, and internalizing symptoms in preadolescence: Is parenting a buffer?

Ecological stress during adolescent development may increase the sensitivity to negative emotional processes that can contribute to the onset and progression of internalizing behaviors during preadolescence. Although a small number of studies have considered the link among the relations between ecological stress, amygdala reactivity, and internalizing symptoms in childhood and adolescence, these studies have largely been small, cross-sectional, and often do not consider unique roles of parenting or sex. In the current study, we evaluated the interrelations between ecological stress, amygdala reactivity, subsequent internalizing symptoms, and the moderating roles of parenting and sex among 9- and 10-year-old preadolescents from the Adolescent Brain Cognitive Development (ABCD) Study ®. A subset of participants who met a priori quality control criteria for bilateral amygdala activation during the EN-back faces versus places contrast (N = 7,385; Mean Age = 120 months, SD = 7.52; 49.5% Female) were included in the study. A confirmatory factor analysis was performed to create a latent variable of ecological stress, and multiple structural equation models were tested to evaluate the association among baseline ecological stress and internalizing symptoms one year later, the mediating role of amygdala reactivity, and moderating effects of parental acceptance and sex. The results revealed a significant association between ecological stress and subsequent internalizing symptoms, which was greater in males than females. There was no association between amygdala reactivity during the Faces versus Places contrast and ecological stress or subsequent internalizing symptoms, and no mediating role of amygdala or moderating effect of parental acceptance on the association between ecological stress and internalizing symptoms. An alternative mediation model was tested which revealed that there was a small mediating effect of parental acceptance on the association between ecological stress and internalizing symptoms, demonstrating lower internalizing symptoms among preadolescents one year later. Given the lack of association in brain function, ecological stress and internalizing symptoms in preadolescents in this registered report, effects from comparable small studies should be reconsidered in larger samples.

Household economic hardship as a moderator of the associations between maternal spanking and child externalizing behavior problems

BACKGROUND

Spanking is associated with detrimental outcomes for young children. Research shows that spanking is more commonly used in low-income households.

OBJECTIVE

To examine whether economic hardship, measured by household income-to-poverty ratio at the time of the child's birth, moderated the longitudinal associations between maternal spanking and child externalizing behavior problems during the first nine years of childhood.

PARTICIPANTS AND SETTING

Mother-child pairs (N = 4,149) from a cohort study of urban families in 20 US cities.

METHODS

Cross-lagged path models examined associations between maternal spanking and externalizing behavior when children were between the ages of 1 and 9. Multigroup analyses examined whether income-to-poverty ratio moderated these associations.

RESULTS

Bivariate analyses showed that income-to-poverty ratio was associated with child externalizing behavior problems at each time point; income-to-poverty ratio was associated with maternal spanking at age 3 only. Longitudinal path model results indicated that, for low- and middle-income groups, maternal spanking at each age had significant associations with child externalizing behavior at each subsequent age. For the high-income group, maternal spanking at age 1 and age 3 had significant associations with child externalizing behavior at each subsequent age; however, spanking at age 5 was not associated with child externalizing behavior at age 9.

CONCLUSIONS

Spanking is disadvantageous for children at all income levels, with more persistent effects in low- and middle-income families. For higher-income families, the associations of maternal spanking with child externalizing behavior problems may be attenuated as child age increases. Regardless of income level, parents should be advised against spanking.

Developing a Measure of the Impact of COVID-19 Social Distancing on Household Conflict and Cohesion

This report introduces the COVID-19 Family Environment Scale (CHES), which aims to measure the impact of social distancing due to COVID-19 on household conflict and cohesion. Existing measures do not capture household experiences relevant to the pandemic, in which families are largely confined to their homes while sharing a life-threatening situation. Using best practice guidelines, we developed a pool of items and revised them with review by a panel of experts, and cognitive interviewing with community respondents. We administered the CHES by online survey to 3,965 adults. The CHES consists of 15 items for each of two subscales, household conflict (α = .847) and household cohesion (α = .887). Exploratory factor analysis yielded two factors, corresponding to the intended conflict and cohesion items, which accounted for 29% of variance. Confirmatory factor analysis partially supported the 2-factor model (RMSEA = .057; CFI = .729, TLI = .708, and SRMR = .098). The CHES also contains 25 optional items to describe respondent and household characteristics, and household-level COVID-19 exposure. The CHES, publicly available at https://elcentro.sonhs.miami.edu/research/measures-library/covid-19/index.html, provides a tool for measuring the impact of the COVID-19 pandemic on important determinants of resilience in the face of major stressful events. Further work is needed to address the factor structure and establish validity of the CHES.