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aguilar E, Perrigo JL, Pereira N, Russ SA, Bader JL, Halfon N. Unveiling early childhood health inequities by age five through the national neighborhood equity index and the early development instrument. SSM Popul Health 2024; 25:101553. [PMID: 38524175 PMCID: PMC10958629 DOI: 10.1016/j.ssmph.2023.101553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 10/27/2023] [Accepted: 10/29/2023] [Indexed: 03/26/2024] Open
Abstract
There is growing public urgency to close equity gaps in health and development by addressing inequities at multiple levels of children's developmental ecosystems. Current measurement strategies obscure the dynamic structural and relational patterns of oppression, adversity, and disadvantage that children can experience in their local intimate developmental ecosystem, as well as the leverage points that are necessary to change them. The purpose of this study is to examine the relationship between a universally available measure of neighborhood socio-economic context, the National Neighborhood Equity Index (NNEI), and a population measure of early child development and well-being, the Early Development Instrument (EDI). Data from a convenience sample of 144,957 kindergarteners in neighborhoods across the US demonstrate that children living in neighborhoods with more equity barriers are more likely to be on vulnerable developmental trajectories than those who reside in neighborhoods without any equity barriers. A multi-dimensional measurement approach that incorporates both the EDI and the NNEI can be used to quantify ethnoracialized patterns of structural disadvantage during critical periods of health development. These measures can inform community action to intervene early in the lifecourse to optimize children's health development trajectories at a population level.
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Affiliation(s)
- efren aguilar
- University of California, Los Angeles (UCLA), Center for Healthier Children, Families, and Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA, 90024, USA
| | - Judith L. Perrigo
- University of California, Los Angeles (UCLA), Center for Healthier Children, Families, and Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA, 90024, USA
- University of California, Los Angeles (UCLA), Luskin School of Public Affairs, Department of Social Welfare, 337 Charles E Young Dr E, Los Angeles, CA, 90095, USA
| | - Nicole Pereira
- University of California, Los Angeles (UCLA), Center for Healthier Children, Families, and Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA, 90024, USA
| | - Shirley A. Russ
- University of California, Los Angeles (UCLA), Center for Healthier Children, Families, and Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA, 90024, USA
- Department of Pediatrics, David Geffen School of Medicine, USA
| | - Joshua L. Bader
- University of California, Los Angeles (UCLA), Center for Healthier Children, Families, and Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA, 90024, USA
| | - Neal Halfon
- University of California, Los Angeles (UCLA), Center for Healthier Children, Families, and Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA, 90024, USA
- Department of Pediatrics, David Geffen School of Medicine, USA
- Department of Health Policy and Management, Feilding School of Public Health, USA
- Department of Public Policy, Luskin School of Public Affairs, USA
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Miller EB, Canfield CF, Barajas-Gonzalez RG, Chung A, Katter J, Kerker BD. The Children, Caregivers, and Community (C3) study of together growing strong: A protocol for an observational, place-based initiative in Sunset Park, Brooklyn. PLoS One 2023; 18:e0290985. [PMID: 37656726 PMCID: PMC10473505 DOI: 10.1371/journal.pone.0290985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/25/2023] [Indexed: 09/03/2023] Open
Abstract
Reaching population-level impact for families in poverty requires moving beyond a sole focus on individuals, to a wider focus on interactions between individuals and their broader environmental contexts. Place-based initiatives have emerged as a policy response to promote community-level change around these broader interactions between individuals and their local communities through addressing long-standing disparities in housing, employment, education, and health. Together Growing Strong (TGS) is one such place-based initiative focused on transforming the health, wellbeing, and development of young children and their families in Sunset Park, Brooklyn. The Children, Caregivers, and Community (C3) Study is an outcomes-based study designed to assess the trajectories of children and families in Sunset Park along indicators such as family health and wellbeing and child development in relation to TGS program participation. The aims, scope, and protocol of the C3 Study are the subjects of this paper.
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Affiliation(s)
- Elizabeth B. Miller
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States of America
| | - Caitlin F. Canfield
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, United States of America
| | | | - Alicia Chung
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States of America
| | - Julie Katter
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States of America
| | - Bonnie D. Kerker
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States of America
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Pinkerton LM, Kisiel CL, Risser HJ. Treatment Engagement Among Children Exposed to Violence: A Systems Perspective. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:4215-4239. [PMID: 35968728 DOI: 10.1177/08862605221114306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Childhood exposure to violence is a major public health issue. Effective treatment can reduce the impact of violence exposure on child outcomes. However, disparities in treatment engagement can interfere with effective treatment. This study reviews data collected from 2,546 children referred to community-based mental health services from 2001 to 2015 after exposure to violence. Children were categorized into three groups: those who attended intake but never started treatment, referred to as the Nonengager group; those who started but discontinued treatment prior to meeting treatment goals, referred to as the Attriter group; and those who completed treatment as rated by the treating therapist, referred to as the Completer group. The three groups were analyzed for differences in behavioral and emotional problems, racial identity, child social support, household income, number of people living in the home, parent stress, parent social support, community violence exposure, and neighborhood-level child opportunity. Analyses demonstrated that the Completer group were more likely to: live in neighborhoods with higher levels of childhood opportunity, identify as White, have an annual household income of $40,000 or greater, have significantly fewer people living in the home, report lower levels of parental stress, report higher levels of parental social support, report higher levels of child social support, and have significantly lower scores of emotional and behavioral problems after treatment. Overall, our study supports the importance of considering multiple ecological levels when targeting treatment engagement for children after exposure to violence. Results indicate that children from more advantaged environments are more likely to complete treatment, which leads to better outcomes. This can exacerbate existing disparities. Findings highlight the need for systems change and advocacy for children in less advantaged environments and meeting families in their specific context, to combat treatment disparities.
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Affiliation(s)
- Linzy M Pinkerton
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Heather J Risser
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Hirschfeld S, Goodman E, Barkin S, Faustman E, Halfon N, Riley AW. Health Measurement Model-Bringing a Life Course Perspective to Health Measurement: The PRISM Model. Front Pediatr 2021; 9:605932. [PMID: 34178878 PMCID: PMC8222802 DOI: 10.3389/fped.2021.605932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 04/27/2021] [Indexed: 01/04/2023] Open
Abstract
Health is a multidimensional concept that is challenging to measure, and in the rapidly evolving developmental changes that occur during the first 21 years of human life, requires a dynamic approach to accurately capture the transitions, and overall arc of a complex process of internal and external interactions. We propose an approach that integrates a lifecourse framework with a layered series of assessments, each layer using a many to many mapping, to converge on four fundamental dimensions of health measurement-Potential, Adaptability, Performance, and Experience. The four dimensions can conceptually be mapped onto a plane with each edge of the resulting quadrilateral corresponding to one dimension and each dimensions assessment calibrated against a theoretical ideal. As the plane evolves over time, the sequential measurements will form a volume. We term such a model the Prism Model, and describe conceptually how single domain assessments can be built up to generate the holistic description through the vehicle of a layer of Exemplar Cases. The model is theoretical but future work can use the framework and principles to generate scalable and adaptable applications that can unify and improve the precision of serial measurements that integrate environmental and physiologic influences to improve the science of child health measurement.
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Affiliation(s)
- Steven Hirschfeld
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Elizabeth Goodman
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | - Shari Barkin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Elaine Faustman
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Neal Halfon
- Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA, United States
| | - Anne W. Riley
- Department of Population, Family, and Reproductive Health, Johns Hopkins University, Baltimore, MD, United States
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Population-Level Data on Child Development at School Entry Reflecting Social Determinants of Health: A Narrative Review of Studies Using the Early Development Instrument. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073397. [PMID: 33805965 PMCID: PMC8037511 DOI: 10.3390/ijerph18073397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/18/2021] [Accepted: 03/20/2021] [Indexed: 12/27/2022]
Abstract
Background: The Early Development Instrument (EDI) was developed as a population-level assessment of children’s developmental health at school entry. EDI data collection has created unprecedented opportunities for population-level studies on children’s developmental outcomes. The goal of this narrative review was to synthesize research using the EDI to describe how it contributes to expanding the understanding of the impacts of social determinants on child development and how it applies to special populations. Methods: Select studies published in peer-reviewed scientific journals between 2015 and 2020 and incorporating the social determinants of health perspectives were chosen to highlight the capability of the EDI to monitor children’s developmental health and contribute knowledge in the area of early childhood development. Results: A number of studies have examined the association between several social determinants of health and children’s developmental outcomes, including hard-to-reach and low-frequency populations of children. The EDI has also been used to evaluate programs and interventions in different countries. Conclusions: The ability of the EDI to monitor children’s developmental outcomes in various populations has been consistently demonstrated. The EDI, by virtue of its comprehensive breadth and census-like collection, widens the scope of research relating to early childhood development and its social determinants of health.
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