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Copeland KA, Porter L, Gorecki MC, Reyner A, White C, Kahn RS. Early Correlates of School Readiness Before and During the COVID-19 Pandemic Linking Health and School Data. JAMA Pediatr 2024; 178:294-303. [PMID: 38315472 PMCID: PMC10845043 DOI: 10.1001/jamapediatrics.2023.6458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/01/2023] [Indexed: 02/07/2024]
Abstract
Importance Many known correlates of kindergarten readiness are captured in developmental and social screenings in primary care; little is known about how primary care data predicts school readiness. Objective To identify early Kindergarten Readiness Assessment (KRA) correlates by linking electronic health record (EHR) data with school district KRA data and to examine potential outcomes of the COVID-19 pandemic using KRA scores between 2018 and 2021. Design, Setting, and Participants This was a retrospective cohort study linking a large primary care practice (PCP) with school assessment data. Linkage used patient name, date of birth, and address. The setting was an urban school district and PCP affiliated with an academic medical center. Students had a KRA score from fall of 2018, 2019, or 2021 (no 2020 KRA due to the COVID-19 pandemic) and at least 1 prior well-child visit at the PCP. Exposures Exposures included year KRA administered, reported child race and ethnicity, child sex, interpreter for medical visits, child ever failed Ages & Stages Questionnaire (ASQ) 18 to 54 months, ever rarely read to, Medicaid status, food insecurity, housing insecurity, problems with benefits, and caregiver depressive symptoms. Main Outcomes and Measures KRA score (continuous), with a possible range of 0 to 300 (passing score = 270). Results A total of 3204 PCP patients (mean [SD] age, 67 [4] months; 1612 male [50.3%]; 2642 Black [82.5%]; 94 Hispanic [2.9%]; 244 White [7.6%]) were matched to their KRA score. Mean (SD) KRA scores were significantly lower in 2021 (mean [SD], 260.0 [13.0]; 214 of 998 [21.4%]) compared with 2019 (mean [SD], 262.7 [13.5]; 317 of 1114 [28.5%]) and 2018 (mean [SD], 263.5 [13.6]; 351 of 1092 [32.1%]), a pattern mirrored in the larger school district. In the linear regression final model (n = 2883), the following binary variables significantly lowered the child's KRA score (points lowered [95% CI]) below a mean passing score of 270.8: child ever failed ASQ after 18 months (-6.7; 95% CI, -7.7 to -5.6), Medicaid insured (-5.7; 95% CI, -9.0 to -2.3), Hispanic ethnicity (-3.8; 95% CI, -6.9 to -0.6), requires interpreter (-3.6; 95% CI, -7.1 to -0.1), 2021 year (-3.5; 95% CI, -4.7 to -2.3), male sex (-2.7; 95% CI, -3.7 to -1.8), ever rarely read to (-1.5; 95% CI, -2.6 to -0.4), and food insecurity (-1.2; 95% CI, -2.4 to -0.1). Race, caregiver depression, housing insecurity, and problems receiving benefits were not associated with KRA scores in final model. Conclusions and Relevance Findings of this cohort study suggest a deleterious association of the COVID-19 pandemic with early learning and development. There may be potential for PCPs and school districts to collaborate to identify and mitigate risks much earlier.
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Affiliation(s)
- Kristen A. Copeland
- Fisher Child Health Equity Center, James M. Anderson Center for Health Systems Excellence, Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lauren Porter
- James M. Anderson Center for Health Systems Excellence, Cincinnati, Ohio
| | - Michelle C. Gorecki
- General Pediatrics Research Program, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Allison Reyner
- James M. Anderson Center for Health Systems Excellence, Cincinnati, Ohio
| | - Cynthia White
- James M. Anderson Center for Health Systems Excellence, Cincinnati, Ohio
| | - Robert S. Kahn
- Fisher Child Health Equity Center, Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Jensen A, Rochow N, Voigt M, Neuhäuser G. Differential effects of growth restriction and immaturity on predicted psychomotor development at 4 years of age in preterm infants. AJOG GLOBAL REPORTS 2024; 4:100305. [PMID: 38327671 PMCID: PMC10847025 DOI: 10.1016/j.xagr.2023.100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Fetal growth restriction and immaturity are associated with poor neurocognitive development and child psychopathology affecting educational success at school and beyond. However, the differential effects of either obstetrical risk factor on predicted psychomotor development have not yet been deciphered. OBJECTIVE This study aimed to separately study the impact of growth restriction and that of immaturity on predicted psychomotor development at the preschool age of 4.3 (standard deviation, 0.8) years using birthweight percentiles in a prospective cohort of preterm infants born at ≤37+6/7 weeks of gestation. Differences between small for gestational age newborns with intrauterine growth restriction and those without were described. We examined predicted total psychomotor development score, predicted developmental disability index, calculated morphometric vitality index, and predicted intelligence quotient, Porteus Maze test score, and neurologic examination optimality score in 854 preterm infants from a large prospective screening cohort (cranial ultrasound screening, n=5,301). STUDY DESIGN This was a prospective cranial ultrasound screening study with a single-center cohort observational design (data collection done from 1984-1988, analysis done in 2022). The study included 5,301 live-born infants, of whom 854 (16.1%) were preterm infants (≤37+6/7 weeks' gestation), and was conducted on the day of discharge of the mother at 5 to 8 days postpartum from a level 3 perinatal center. Predicted psychomotor development, as assessed by the predicted total psychomotor development score, predicted developmental disability index, calculated morphometric vitality index, predicted intelligence quotient, Porteus Maze test score, and neurologic examination optimality score were calculated. We related psychomotor development indices and measures to gestational age in 3 groups of birthweight percentiles (ie, 10%, 50%, and 90% for small, appropriate, and large for gestational age newborns, respectively) using linear regression analysis, analysis of variance, multivariate analysis of variance, and t test procedures. RESULTS The key result of our study is the observation that in preterm infants born at ≤37+6/7 weeks of gestation, growth restriction as compared with immaturity is the prime risk factor for impairment of overall predicted psychomotor development, intelligence quotient, Porteus Maze test results, and neurologic examination optimality score at the preschool age of 4.3 (standard deviation, 0.8) years (P<.001). This is particularly true for intrauterine growth restriction. These detrimental effects of growth restriction become more prominent with decreasing gestational age (P<.001). As expected, growth restriction in preterm infants born at ≤37+6/7 weeks of gestation was associated with a number of obstetrical risk factors, including hypertension in pregnancy (P<.001), multiple pregnancy (P<.001), pathologic cardiotocography (P=.001), and low pH (P=.007), increased pCO2 (P=.009), and poor pO2 (P<.001) in umbilical arterial blood. Of note, there were no differences in cerebral hemorrhage or white matter damage among small, appropriate, and large for gestational age birthweight percentile groups, suggesting an independent mechanism of brain injury caused by preterm growth restriction resulting in poor psychomotor development. CONCLUSION Compared with immaturity, growth restriction in preterm infants has more intense detrimental effects on psychomotor development, necessitating improved risk stratification. This finding has implications for clinical management, parental consultation, and early intervention strategies to improve school performance, educational success, and mental health in children. The mechanisms of brain injury specific to growth restriction in preterm infants require further elucidation.
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Affiliation(s)
- Arne Jensen
- Campus Clinic Gynecology, Ruhr-University Bochum, Germany (Dr Jensen)
| | - Niels Rochow
- Department of Pediatrics, Paracelsus Medical University, Nuremberg, Germany (Dr Rochow)
- Department of Pediatrics, University Medicine Rostock, Rostock, Germany (Dr Rochow)
- DEUZWEG German Center for Growth, Development and Health Promotion in Childhood and Adolescence, Berlin, Germany (Drs Rochow and Voigt)
| | - Manfred Voigt
- DEUZWEG German Center for Growth, Development and Health Promotion in Childhood and Adolescence, Berlin, Germany (Drs Rochow and Voigt)
- Institute for Perinatal Growth Research, Sievershagen, Germany (Dr Voigt)
| | - Gerhard Neuhäuser
- Department of Paediatric Neurology, University of Giessen, Germany (Dr Neuhäuser)
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Rosen F, Settel L, Irvine F, Koselka EPD, Miller JD, Young SL. Associations between food insecurity and child and parental physical, nutritional, psychosocial and economic well-being globally during the first 1000 days: A scoping review. MATERNAL & CHILD NUTRITION 2024; 20:e13574. [PMID: 37828823 PMCID: PMC10750018 DOI: 10.1111/mcn.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
Food insecurity affects billions of individuals annually and contributes to myriad poor health outcomes. Experiences of food insecurity may be particularly harmful during the first 1000 days, but literature on the topic has not been synthesized. We therefore aimed to characterize all available studies examining associations between food insecurity and nutritional, psychosocial, physical and economic well-being among parents and children during this period. We implemented a standardized search strategy across 11 databases. Four researchers screened 10,257 articles, 120 of which met the inclusion criteria. Most studies were conducted in Sub-Saharan Africa (43.3%), followed by North America (20.8%). Studies were primarily quantitative (95.8%), cross-sectional (70.0%) and focused on women (pregnant or post-partum, 48.3%) or women and children (15.8%). Physical health outcomes were the most investigated (n = 87 studies), followed by nutritional (n = 69), psychosocial (n = 35) and economic well-being (n = 2). The most studied associations were between food insecurity and stunting (n = 15), maternal depression (n = 12), child dietary diversity (n = 7) and maternal body mass index (n = 6). The strength of evidence for the observed associations varied across populations as well as within and between examined outcomes. We recommend that future studies recruit more diverse study populations, consider temporality of relationships, use instruments that facilitate cross-site comparisons, measure individual-level food insecurity and outcomes most likely to be impacted by food insecurity, evaluate contextual factors that may modify the effects of food insecurity and employ analytic techniques that permit assessment of causal pathways.
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Affiliation(s)
- Francesca Rosen
- Department of Global Health StudiesNorthwestern UniversityEvanstonIllinoisUSA
| | - Lily Settel
- Department of Global Health StudiesNorthwestern UniversityEvanstonIllinoisUSA
- Department of AnthropologyNorthwestern UniversityEvanstonIllinoisUSA
| | - Faith Irvine
- Department of Global Health StudiesNorthwestern UniversityEvanstonIllinoisUSA
| | | | - Joshua D. Miller
- Department of AnthropologyNorthwestern UniversityEvanstonIllinoisUSA
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Sera L. Young
- Department of AnthropologyNorthwestern UniversityEvanstonIllinoisUSA
- Institute for Policy ResearchNorthwestern UniversityEvanstonIllinoisUSA
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Woodbury ML, Cintora P, Ng S, Hadley PA, Schantz SL. Examining the relationship of acetaminophen use during pregnancy with early language development in children. Pediatr Res 2023:10.1038/s41390-023-02924-4. [PMID: 38081897 PMCID: PMC11164826 DOI: 10.1038/s41390-023-02924-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 03/21/2024]
Abstract
BACKGROUND Acetaminophen is the only analgesic considered safe for use throughout pregnancy. Recent studies suggest that use during pregnancy may be associated with poorer neurodevelopmental outcomes in children, but few have examined language development. METHODS The Illinois Kids Development Study is a prospective birth cohort in east-central Illinois. Between December 2013 and March 2020, 532 newborns were enrolled and had exposure data available. Participants reported the number of times they took acetaminophen six times across pregnancy. Language data were collected at 26.5-28.5 months using the MacArthur-Bates Communicative Development Inventories (CDI; n = 298), and 36-38 months using the Speech and Language Assessment Scale (SLAS; n = 254). RESULTS Taking more acetaminophen during the second or third trimester was associated with marginally smaller vocabularies and shorter utterance length (M3L) at 26.5-28.5 months. More acetaminophen use during the third trimester was also associated with increased odds of M3L scores ≤25th percentile in male children. More use during the second or third trimester was associated with lower SLAS scores at 36-38 months. Third trimester use was specifically related to lower SLAS scores in male children. CONCLUSIONS Higher prenatal acetaminophen use during pregnancy may be associated with poorer early language development. IMPACT Taking more acetaminophen during pregnancy, particularly during the second and third trimesters, was associated with poorer scores on measures of language development when children were 26.5-28.5 and 36-38 months of age. Only male children had lower scores in analyses stratified by child sex. To our knowledge, this is the first study that has used a standardized measure of language development to assess the potential impact of prenatal exposure to acetaminophen on language development. This study adds to the growing body of literature suggesting that the potential impact of acetaminophen use during pregnancy on fetal neurodevelopment should be carefully evaluated.
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Affiliation(s)
- Megan L Woodbury
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- College of Engineering, Northeastern University, Boston, MA, USA.
| | - Patricia Cintora
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Shukhan Ng
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Pamela A Hadley
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Susan L Schantz
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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5
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Jensen A, Neuhäuser G. Growth variables and obstetrical risk factors in newborns are associated with psychomotor development at preschool age. AJOG GLOBAL REPORTS 2023; 3:100219. [PMID: 37719644 PMCID: PMC10504534 DOI: 10.1016/j.xagr.2023.100219] [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] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Low birthweight resulting from preterm birth or fetal growth restriction is associated with poor neurocognitive development and child psychopathology affecting school performance and educational success. Prediction of developmental performance may therefore serve as a basis for early intervention strategies to improve educational success and mental health of our children in a timely manner. OBJECTIVE This study aimed to explore the predictive capacity of morphometric variables taken at birth and that of obstetrical risk factors to predict developmental performance at 4.3 (standard deviation, 0.8) years preschool age. We examined predicted Total psychomotor development score, predicted Developmental disability index, calculated Morphometric vitality index, and predicted Intelligence quotient, Maze test, and Neurologic examination optimality score in a large prospective screening (cranial ultrasound screening, n=5,301) and validation cohort (n=508,926). STUDY DESIGN In a single-center cohort observational study design (data collection done from 1984-1988, analysis done in 2022), a prospective cranial ultrasound screening study (1984-1988) was carried out on 5,301 live-born infants, including 571 (10.8%) preterm infants (≤36 weeks gestation), on the day of discharge of the mother at 5 to 8 days postpartum from a level 3 perinatal center. Predicted psychomotor development as assessed by predicted Total psychomotor development score, predicted Developmental disability index, calculated Morphometric vitality index, and predicted Intelligence quotient, Maze test, and Neurologic examination optimality score, was calculated. We related growth variables and obstetrical risk factors to Psychomotor development indices, and calculated Morphometric vitality index using odds ratios, receiver operating characteristics, analysis of variance, and multivariate analysis of variance. RESULTS The key result of our study is the observation that simple morphometric measures from newborns at birth like weight/head circumference ratio predict overall psychomotor development at 4.3 years (standard deviation, 0.8) of preschool age. Psychomotor development was assessed by predicted Total psychomotor development score, predicted Intelligence quotient, Maze test, and Neurologic examination optimality score, and related to weight/head circumference ratio in linear regression (P<.001) and ROC curve analyses (P<.001). Further, white matter damage strongly predicted adverse outcome in predicted Developmental disability index (P<.001). There was also a close correlation between calculated Morphometric vitality index and predicted Developmental disability index (P<.001). Finally, brain body weight ratio, weight/head circumference ratio, preterm birth, reduced Apgar at 10 minutes, weight/length ratio, and white matter damage yielded highest odds ratios for adverse outcome in predicted Total psychomotor development score and in predicted Developmental disability index (P<.001) and high effect sizes in reduced predicted Intelligence quotient, Maze test, and Neurologic examination optimality scores. CONCLUSION Simple morphometric data, birth variables, and obstetrical risk factors bear predictive capacity for neurocognitive performance in children at 4.3 years (standard deviation, 0.8) of age and hence provide a basis for parental consultation and early intervention to improve school performance, educational success, and mental health in developed and developing countries.
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Affiliation(s)
- Arne Jensen
- Campus Clinic Gynecology, Ruhr-University Bochum, Bochum, Germany (Dr Jensen)
| | - Gerhard Neuhäuser
- Department of Paediatric Neurology, University of Giessen, Giessen, Germany (Dr Neuhäuser)
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6
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Obradović J, Finch JE, Connolly C, Siyal S, Yousafzai AK. The unique relevance of executive functions and self-regulation behaviors for understanding early childhood experiences and preschoolers' outcomes in rural Pakistan. Dev Sci 2022; 25:e13271. [PMID: 35561073 DOI: 10.1111/desc.13271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 04/13/2022] [Accepted: 04/07/2022] [Indexed: 01/13/2023]
Abstract
Performance-based measures of children's executive functions (EFs) do not capture children's application of these skills during everyday emotionally-laden and socially-mediated interactions. The current study demonstrates the value of using assessor report of self-regulation behaviors (inhibitory control and positive affect/engagement) in addition to EF tasks when studying early childhood experiences and development in a rural lower-middle-income country setting. In a sample of 1302 disadvantaged 4-year-olds living in rural Pakistan, we found that directly assessed EFs were significantly related to assessor observations of children's inhibitory control and positive affect/engagement during a structured assessment protocol. However, EFs and two types of self-regulation behaviors demonstrated unique associations with children's (1) contextual experiences, as indexed by family socio-economic resources, participation in parenting interventions, and children's physical growth; and (2) age-salient developmental outcomes, as indexed by direct assessment of pre-academic skills and maternal report of prosocial behaviors and behavior problems. First, family wealth uniquely predicted only observed positive affect/engagement, whereas maternal education uniquely predicted only EFs. Second, children's antecedent linear growth was a significant predictor of both EFs and positive affect/engagement, but exposure to an enhanced nutrition intervention during the first 2 years of life and preschoolers' hair cortisol concentration were associated only with observed self-regulation behaviors. Finally, both EFs and observed positive affect/engagement uniquely predicted children's pre-academic skills. In contrast, only assessors' ratings of positive affect/engagement uniquely predicted maternal report of prosocial behaviors and only assessors' ratings of inhibitory control uniquely predicted maternal report of behavioral problems.
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Affiliation(s)
- Jelena Obradović
- Graduate School of Education, Stanford University, Stanford, California, USA
| | - Jenna E Finch
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Catie Connolly
- Graduate School of Education, Stanford University, Stanford, California, USA
| | - Saima Siyal
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.,DREAM Community Development and Research Organization, Naushahero Feroze, Pakistan
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Gallardo M, Zepeda A, Biely C, Jackson N, Puffer M, Anton P, Dudovitz R. School-Based Health Center Utilization During COVID-19 Pandemic-Related School Closures. THE JOURNAL OF SCHOOL HEALTH 2022; 92:1045-1050. [PMID: 35945893 PMCID: PMC9538881 DOI: 10.1111/josh.13226] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Little is known regarding utilization of school-based health centers (SBHCs) during prolonged school closures, such as those that occurred during the COVID-19 pandemic. We sought to compare SBHC utilization before and after pandemic-related school closures across a network of SBHCs affiliated with a large Southern Californian urban school district. METHODS We conducted a secondary analysis of encounter data extracted from electronic health records from 12 SBHCs that remained open despite school closures, including patient demographics and diagnostic and billing codes. We used the Clinical Classifications Software Refined to group encounters for common primary care conditions. Utilization before and during pandemic-related school closures was compared using logistic regression with cluster-robust standard errors to account for clustering within clinics, after adjusting for month of encounter. RESULTS During the pandemic, study SBHCs conducted 52,530 encounters and maintained ∼4040 encounters/month. The frequency of encounters for annual preventative health exams increased for school-aged patients but decreased for other age groups while the frequency of encounters for mental health problems increased for all age groups. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY Despite pandemic-related school closures, SBHCs appeared play a critical role in providing primary care to vulnerable communities. CONCLUSIONS SBHCs may hold value beyond their co-location with academic instruction.
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Affiliation(s)
| | - Alex Zepeda
- The L.A. Trust for Children's HealthLos AngelesCA
| | - Christopher Biely
- David Geffen School of Medicine at UCLA, Los Angeles, CA; UCLA Department of PediatricsLos AngelesCA
| | - Nicholas Jackson
- David Geffen School of Medicine at UCLA, Los Angeles, CA; UCLA General Internal MedicineLos AngelesCA
| | | | | | - Rebecca Dudovitz
- David Geffen School of Medicine at UCLA, Los Angeles, CA; UCLA Department of PediatricsLos AngelesCA
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Cain KS, Meyer SC, Cummer E, Patel KK, Casacchia NJ, Montez K, Palakshappa D, Brown CL. Association of Food Insecurity with Mental Health Outcomes in Parents and Children. Acad Pediatr 2022; 22:1105-1114. [PMID: 35577282 PMCID: PMC10153634 DOI: 10.1016/j.acap.2022.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/07/2022] [Accepted: 04/30/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Food insecurity affects 13.7 million US households and is linked to poor mental health. Families shield children from food insecurity by sacrificing their nutritional needs, suggesting parents and children experience food insecurity differentially. OBJECTIVE To identify the associations of food insecurity and mental health outcomes in parents and children DATA SOURCES: PubMed, Embase, Web of Science, and PsycInfo STUDY ELIGIBILITY CRITERIA: We included original research published in English from January 1990 to June 2020 that examined associations between food insecurity and mental health in children or parents/guardians in the United States. STUDY APPRAISAL AND SYNTHESIS METHODS Two reviewers screened studies for inclusion. Data extraction was completed by one reviewer and checked by a second. Bias and confounding were assessed using the Agency for Healthcare Research and Quality RTI Item Bank. Studies were synthesized qualitatively, grouped by mental health outcome, and patterns were assessed. Meta-analyses were not performed due to high variability between studies. RESULTS We included 108 studies, assessing 250,553 parents and 203,822 children in total. Most studies showed a significant association between food insecurity and parental depression, anxiety, and stress, and between food insecurity and child depression, externalizing/internalizing behaviors, and hyperactivity. LIMITATIONS Most studies were cross-sectional and many were medium- or high-risk for bias or confounding. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Food insecurity is significantly associated with various mental health outcomes in both parents and children. The rising prevalence of food insecurity and mental health problems make it imperative that effective public health and policy interventions address both problems.
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Affiliation(s)
- Kathryn S Cain
- Department of Pediatrics (KS Cain, SC Meyer, E Cummer, KK Patel, K Montez, D Palakshappa, and CL Brown), Wake Forest School of Medicine, Winston-Salem, NC
| | - Stephanie C Meyer
- Department of Pediatrics (KS Cain, SC Meyer, E Cummer, KK Patel, K Montez, D Palakshappa, and CL Brown), Wake Forest School of Medicine, Winston-Salem, NC
| | - Elaina Cummer
- Department of Pediatrics (KS Cain, SC Meyer, E Cummer, KK Patel, K Montez, D Palakshappa, and CL Brown), Wake Forest School of Medicine, Winston-Salem, NC
| | - Kishan K Patel
- Department of Pediatrics (KS Cain, SC Meyer, E Cummer, KK Patel, K Montez, D Palakshappa, and CL Brown), Wake Forest School of Medicine, Winston-Salem, NC
| | - Nicholas J Casacchia
- Clinical and Translational Science Institute (NJ Casacchia), Wake Forest University, Winston-Salem, NC
| | - Kimberly Montez
- Department of Pediatrics (KS Cain, SC Meyer, E Cummer, KK Patel, K Montez, D Palakshappa, and CL Brown), Wake Forest School of Medicine, Winston-Salem, NC
| | - Deepak Palakshappa
- Department of Pediatrics (KS Cain, SC Meyer, E Cummer, KK Patel, K Montez, D Palakshappa, and CL Brown), Wake Forest School of Medicine, Winston-Salem, NC; Department of Internal Medicine (D Palakshappa), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology and Prevention (D Palakshappa, CL Brown), Wake Forest School of Medicine, Winston-Salem, NC
| | - Callie L Brown
- Department of Pediatrics (KS Cain, SC Meyer, E Cummer, KK Patel, K Montez, D Palakshappa, and CL Brown), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology and Prevention (D Palakshappa, CL Brown), Wake Forest School of Medicine, Winston-Salem, NC.
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Lutenbacher M, Elkins T, Dietrich MS. Using Community Health Workers to Improve Health Outcomes in a Sample of Hispanic Women and Their Infants: Findings from a Randomized Controlled Trial. HISPANIC HEALTH CARE INTERNATIONAL 2022:15404153221107680. [PMID: 35702003 DOI: 10.1177/15404153221107680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: The Maternal Infant Health Outreach Worker (MIHOW) program, an early childhood home visiting program, uses community health workers (CHWs) to improve health outcomes in underserved communities. Methods: This randomized clinical trial evaluated the impact of MIHOW's use of CHWs on selected maternal/infant outcomes up to 15 months postpartum. We hypothesized outcomes would be better among Hispanic women receiving MIHOW compared to a similar group of women eligible for MIHOW who received only a minimal education intervention (MEI). The study also expanded earlier research testing MIHOW's efficacy among Hispanic families using criteria set forth by federal guidelines. Women living in middle Tennessee enrolled during pregnancy (≤26 weeks gestation) and continued through 15 months postpartum. Results: Enrolled women (N = 132) were randomly assigned, with 110 women completing the study (MEI = 53; MIHOW = 57). Positive and statistically significant (p < .01) effects of MIHOW were observed on breastfeeding duration, safe sleep practices, stress levels, depressive symptoms, emotional support, referral follow through, parental confidence, and infant stimulation in the home. Conclusions: Findings provided strong evidence of the effectiveness of MIHOW for improving health outcomes in this sample. Using trained CHWs makes programs such as MIHOW a viable option for providing services to immigrant and underserved families.
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Affiliation(s)
| | - Tonya Elkins
- 16194Vanderbilt University School of Nursing, Nashville, TN, USA
| | - Mary S Dietrich
- 16194Vanderbilt University School of Nursing, Nashville, TN, USA.,5718Vanderbilt University School of Medicine (Biostatistics, Hearing and Speech), Nashville, TN, USA
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Koziol NA, Butera CD, Kretch KS, Harbourne RT, Lobo MA, McCoy SW, Hsu LY, Willett SL, Kane AE, Bovaird JA, Dusing SC. Effect of the START-Play Physical Therapy Intervention on Cognitive Skills Depends on Caregiver-Provided Learning Opportunities. Phys Occup Ther Pediatr 2022; 42:510-525. [PMID: 35350970 DOI: 10.1080/01942638.2022.2054301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
Abstract
AIMS This study evaluated whether caregiver-provided learning opportunities moderated the effect of START-Play physical therapy intervention on the cognitive skills of young children with neuromotor delays, and whether START-Play impacted caregiver-provided learning opportunities over time. METHODS One hundred and twelve children with neuromotor delays (7-16 months) participated in a multisite randomized clinical trial evaluating the efficacy of START-Play. Children were assessed at baseline and 3 (post intervention), 6, and 12 months post baseline. Cognition was scored from the Bayley Scales of Infant & Toddler Development, Third Edition, cognitive scale. The proportion of time caregivers spent providing learning opportunities was coded from a 5-minute caregiver-child free play interaction. RESULTS Baseline caregiver-provided learning opportunities moderated the 3- and 12-month effects of START-Play on cognition. Cognitive gains due to START-Play were more pronounced for children whose caregivers provided more learning opportunities. START-Play did not impact caregiver-provided learning opportunities over time. CONCLUSIONS START-Play may have a lasting effect on children's cognition, but this effect is contingent on caregivers providing their child with ample opportunities to practice cognitive skills. Strategies for improving caregivers' uptake and transfer of START-Play principles to their daily routines should be evaluated. TRIAL REGISTRATION ClinicalTrials.gov NCT02593825.
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Affiliation(s)
| | | | - Kari S Kretch
- University of Southern California, Los Angeles, California, USA
| | | | | | | | - Lin-Ya Hsu
- University of Washington, Seattle, Washington, USA
| | - Sandra L Willett
- Munroe Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Audrey E Kane
- Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Stacey C Dusing
- University of Southern California, Los Angeles, California, USA
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11
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Orr CJ, Ritter V, Coker TR, Perrin EM, Flower KB. Time-Varying Associations between Food Insecurity and Infant and Maternal Health Outcomes. J Nutr 2022; 152:1291-1297. [PMID: 35084466 PMCID: PMC9272420 DOI: 10.1093/jn/nxac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Food insecurity (FI) is dynamic for families and adversely affects infant and maternal health. However, few studies have examined the longitudinal impact of FI on infant and maternal health. OBJECTIVES We aimed to examine the relation between food insecurity in the first year of life and infant and maternal health outcomes. We hypothesized FI would be associated with poorer infant and maternal health outcomes. METHODS We conducted a retrospective cohort study of 364 infants 12-15 months and their caregivers receiving care at a single primary care clinic. The exposure of interest was food insecurity measured during well-child checks using a validated 2-item screening tool. The primary outcome was infant weight-for-length z score. Secondary outcomes included infant log-transformed ferritin, infant hemoglobin, infant lead concentrations, and maternal depression, assessed by the Edinburgh Postnatal Depression Scale. Unadjusted and adjusted effects were estimated using generalized mixed linear models, and the linear effect of visit time was tested using likelihood ratios. RESULTS In adjusted models, no overall association between FI and infant weight-for-length z score was observed; however, FI male infants had lower weight-for-length z scores than female infants (P = 0.05). FI infants had 14% lower log ferritin concentrations per month of exposure to FI. FI was positively associated with maternal depression (IRR 5.01 [95% CI 2.21-11.3]). CONCLUSIONS Food insecurity can have longitudinal and demographically-varied associations with infant and maternal outcomes that warrant further exploration.
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Affiliation(s)
| | - Victor Ritter
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, WA, USA
| | - Eliana M Perrin
- Department of Pediatrics, School of Medicine and School of Nursing, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Kori B Flower
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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12
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Martin KJ, Beck AF, Xu Y, Szumlas GA, Hutton JS, Crosh CC, Copeland KA. Shared Reading and Risk of Social-Emotional Problems. Pediatrics 2022; 149:183798. [PMID: 34889450 DOI: 10.1542/peds.2020-034876] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The American Academy of Pediatrics recommends literacy promotion as well as routine developmental surveillance during well-child visits to improve academic, relational, and health outcomes. In this study, we examined the possible association between shared reading and social-emotional problems among young children. METHODS We conducted a retrospective review of longitudinal records for children aged 30 to 66 months presenting for visits to an academic pediatric primary care center between July 1, 2013, and February 1, 2019. The outcome was evidence of social-emotional problems, defined by an Ages and Stages: Social Emotional Questionnaire (ASQ:SE) score above the established cutoff. The predictor was caregiver-reported frequency of shared reading (most = 5-7 days per week, some = 2-4 days per week, rarely = 0-1 days per week) at a previous visit. Generalized linear models with generalized estimating equations were used to assess the association between the longitudinal outcome and predictor, adjusting for child demographics and needs reported on routine social history questionnaires. RESULTS Analyses included 5693 children who completed at least 1 ASQ:SE (total of 7302 assessments) and had shared reading frequency documented before each ASQ:SE assessment. Children were predominantly Black (75%) and publicly insured (80%). Sixteen percent of ASQ:SE scores were suggestive of social-emotional concerns; 6% of caregivers reported sharing reading rarely. Children with rare shared reading had a higher risk of an ASQ:SE above cutoff compared with those with shared reading on most days (adjusted risk ratio, 1.62; 95% confidence interval, 1.35-1.92). CONCLUSIONS Less-frequent caregiver-reported shared reading was associated with higher risk of social-emotional problems in young children presenting for primary care. This highlights potential relational and social-emotional benefits of shared reading.
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Affiliation(s)
- Keith J Martin
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew F Beck
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Yingying Xu
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Gregory A Szumlas
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - John S Hutton
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Clare C Crosh
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kristen A Copeland
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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13
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Riley BRW, de Sam Lazaro SL. Role of Occupational Therapy in Pediatric Primary Care: Promoting Childhood Development. Am J Occup Ther 2021; 75:23081. [PMID: 34817597 DOI: 10.5014/ajot.2021.756002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Occupational therapy practitioners have the opportunity to promote development for all children as new service delivery models are established for pediatric primary care. Three action steps are identified: (1) advocacy for legislation that requires developmental screenings and surveillance, (2) support of culturally responsive developmental monitoring, and (3) building evidence for occupational therapy in primary care settings. This article describes the role of occupational therapy practitioners on pediatric interprofessional teams in encouraging family capacity within the scope of health promotion and universal developmental monitoring.
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Affiliation(s)
- Bonnie R W Riley
- Bonnie R. W. Riley, OTD, OTR/L, is Assistant Professor, Department of Occupational Therapy, Ithaca College, Ithaca, NY;
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14
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Barnard-Brak L, Morales-Alemán MM, Tomeny K, McWilliam RA. Rural and Racial/Ethnic Differences in Children Receiving Early Intervention Services. FAMILY & COMMUNITY HEALTH 2021; 44:52-58. [PMID: 33214410 DOI: 10.1097/fch.0000000000000285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A review of the literature shows that racial and ethnic minority children (eg, African American, Asian, and Hispanic) received diagnoses for developmental concerns later in life compared with their age-matched white counterparts. Research has also documented disparities in access to and receipt of health care services among children with developmental concerns as compared with children with other disabilities. OBJECTIVES We examined health care providers' (HCPs') responses to parents' developmental concerns about their children. We looked at the association with race, ethnicity, gender, rurality, and time to diagnosis. METHODS All data were secondary and derived from the Centers for Disease Control and Prevention's Survey of Pathways to Diagnosis and Services. Participants consisted of 1321 parents of children who had received early intervention services as reported by respondents' data collected in 2011. RESULTS From a nationally representative sample of families receiving early intervention services, 76% were white, 10% were African American, 3% were Asian, 5% were Native American, and 9% were Hispanic. Families who were Hispanic were more likely to have received only a delaying response from HCPs. The average time to a developmental delay diagnosis was 5 months longer for families who received a delaying HCP response. CONCLUSIONS Families who were Hispanic or who were from rural areas were most likely to receive a delayed HCP response; for parents who received a delayed HCP response, a developmental delay diagnosis took 5 months longer than for families from the other groups listed.
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Affiliation(s)
- Lucy Barnard-Brak
- Departments of Special Education and Multiple Abilities (Drs Barnard-Brak, Tomeny, and McWilliam) and Community Medicine and Population Health (Dr Morales-Alemán), The University of Alabama, Tuscaloosa
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15
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Guerrero AD, Biely C, Dudovitz R, Coker T, Iyer S, Barnert E, Szilagyi P, Szilagyi M, Chung PJ. Measurement and Identification of Parenting Behaviors Associated with Social-Emotional Outcomes in Children: The Racial and Cultural Appropriateness of a Commonly Used Parenting Measure. J Dev Behav Pediatr 2021; 42:524-531. [PMID: 34010228 PMCID: PMC8440330 DOI: 10.1097/dbp.0000000000000933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to examine parenting styles (observed parent-child interactions via the Two-Bag Task) associated with young children's socioemotional outcomes, comparing children from Mexican-American and African American families with children from their White counterparts. METHODS The Early Childhood Longitudinal Study Birth Cohort data were used to examine 6 global parenting styles with socioemotional outcomes at 48 months of age while controlling for both time-independent and time-depending sociodemographic, maternal mental health, and child characteristics. Data were stratified by race and ethnicity, and weighted longitudinal linear regressions models were estimated using STATA/Xtmixed. RESULTS The 6 global parenting scores from the Two-Bag Task measures differed across White, African American, and Mexican-American groups of parents. White parents on average scored higher on parenting styles related to sensitivity, positive regard, and cognitive stimulation, whereas Mexican-American and African American parents scored lower. These parenting styles were associated with both approach to learning and social competence outcomes among White children but were nearly nonexistent for Mexican-American and African American children when adjusting for covariates. CONCLUSION Our results highlight the need to critically evaluate measures of parenting behaviors used in research studies with racially and ethnically diverse families. Examining the comprehensive psychometric properties and cultural appropriateness of parenting measures for diverse families is important to optimally support child development for non-White children. Furthermore, a critical lens is important to mitigate the perpetuation of inaccurate research findings for Mexican-American and African American children.
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Affiliation(s)
- Alma D Guerrero
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Children's Discovery and Innovation Institute Mattel Children's Hospital UCLA, Los Angeles, CA
| | - Christopher Biely
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Children's Discovery and Innovation Institute Mattel Children's Hospital UCLA, Los Angeles, CA
| | - Rebecca Dudovitz
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Children's Discovery and Innovation Institute Mattel Children's Hospital UCLA, Los Angeles, CA
| | - Tumaini Coker
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Sai Iyer
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Children's Discovery and Innovation Institute Mattel Children's Hospital UCLA, Los Angeles, CA
| | - Elizabeth Barnert
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Children's Discovery and Innovation Institute Mattel Children's Hospital UCLA, Los Angeles, CA
| | - Peter Szilagyi
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Children's Discovery and Innovation Institute Mattel Children's Hospital UCLA, Los Angeles, CA
| | - Moira Szilagyi
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Children's Discovery and Innovation Institute Mattel Children's Hospital UCLA, Los Angeles, CA
| | - Paul J Chung
- Kaiser Permanente School of Medicine, Pasadena, CA
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16
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Ramanathan S, Balasubramanian N, Faraone SV. Association between transient financial stress during early childhood and pre‐school cognitive and socioemotional development. INFANT AND CHILD DEVELOPMENT 2021. [DOI: 10.1002/icd.2267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Stephen V. Faraone
- Department of Psychiatry SUNY Upstate Medical University Syracuse New York USA
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17
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Huang Y, Li W, Macheret F, Gabriel RA, Ohno-Machado L. A tutorial on calibration measurements and calibration models for clinical prediction models. J Am Med Inform Assoc 2021; 27:621-633. [PMID: 32106284 PMCID: PMC7075534 DOI: 10.1093/jamia/ocz228] [Citation(s) in RCA: 153] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 12/18/2019] [Accepted: 01/02/2020] [Indexed: 12/23/2022] Open
Abstract
Our primary objective is to provide the clinical informatics community with an introductory tutorial on calibration measurements and calibration models for predictive models using existing R packages and custom implemented code in R on real and simulated data. Clinical predictive model performance is commonly published based on discrimination measures, but use of models for individualized predictions requires adequate model calibration. This tutorial is intended for clinical researchers who want to evaluate predictive models in terms of their applicability to a particular population. It is also for informaticians and for software engineers who want to understand the role that calibration plays in the evaluation of a clinical predictive model, and to provide them with a solid starting point to consider incorporating calibration evaluation and calibration models in their work. Covered topics include (1) an introduction to the importance of calibration in the clinical setting, (2) an illustration of the distinct roles that discrimination and calibration play in the assessment of clinical predictive models, (3) a tutorial and demonstration of selected calibration measurements, (4) a tutorial and demonstration of selected calibration models, and (5) a brief discussion of limitations of these methods and practical suggestions on how to use them in practice.
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Affiliation(s)
- Yingxiang Huang
- Department of Biomedical Informatics, UC San Diego Health, University of California, San Diego, La Jolla, California, USA
| | - Wentao Li
- Department of Biomedical Informatics, UC San Diego Health, University of California, San Diego, La Jolla, California, USA
| | - Fima Macheret
- Department of Biomedical Informatics, UC San Diego Health, University of California, San Diego, La Jolla, California, USA.,Division of Hospital Medicine, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California, San Diego, La Jolla, California, USA
| | - Lucila Ohno-Machado
- Department of Biomedical Informatics, UC San Diego Health, University of California, San Diego, La Jolla, California, USA.,Division of Health Services Research & Development, VA San Diego Healthcare System, San Diego, California, USA
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18
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Hartline-Grafton H, Hassink SG. Food Insecurity and Health: Practices and Policies to Address Food Insecurity among Children. Acad Pediatr 2021; 21:205-210. [PMID: 32653691 PMCID: PMC7347342 DOI: 10.1016/j.acap.2020.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/01/2020] [Accepted: 07/05/2020] [Indexed: 11/23/2022]
Affiliation(s)
| | - Sandra G Hassink
- AAP Institute for Healthy Childhood Weight (SG Hassink), Itasca, Ill
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19
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Household food insecurity and school readiness among preschool-aged children in the USA. Public Health Nutr 2021; 24:1469-1477. [PMID: 33557975 DOI: 10.1017/s1368980021000550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The present study examines the association between mild and moderate-to-severe household food insecurity and school readiness among a nationally representative sample of preschool-aged children. DESIGN Cross-sectional data pertaining to household food availability as well as four domains of school readiness - early learning skills, self-regulation, social-emotional development and physical health & motor development - were employed. SETTING The USA. PARTICIPANTS 15 402 children aged 3-5 years from the 2016-2018 National Survey of Children's Health. RESULTS Both mild and moderate-to-severe food insecurity are associated with an increase in needing support or being at-risk in each of the four school readiness domains, particularly Self-Regulation (IRR = 4·31; CI 2·68, 6·95) and Social-Emotional Development (IRR = 3·43; CI 2·16, 5·45). Furthermore, while nearly half of the children in food-secure households are on-track across all four school readiness domains (47·49 %), only one in four children experiencing moderate-to-severe household food insecurity is on-track across all domains (25·26 %). CONCLUSIONS Household food insecurity is associated with reductions in school readiness among preschool-aged children.
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20
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van Dokkum NH, Reijneveld SA, Heymans MW, Bos AF, de Kroon MLA. Development of a Prediction Model to Identify Children at Risk of Future Developmental Delay at Age 4 in a Population-Based Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228341. [PMID: 33187306 PMCID: PMC7698029 DOI: 10.3390/ijerph17228341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 11/30/2022]
Abstract
Our aim was to develop a prediction model for infants from the general population, with easily obtainable predictors, that accurately predicts risk of future developmental delay at age 4 and then assess its performance. Longitudinal cohort data were used (N = 1983), including full-term and preterm children. Development at age 4 was assessed using the Ages and Stages Questionnaire. Candidate predictors included perinatal and parental factors as well as growth and developmental milestones during the first two years. We applied multiple logistic regression with backwards selection and internal validation, and we assessed calibration and discriminative performance (i.e., area under the curve (AUC)). The model was evaluated in terms of sensitivity and specificity at several cut-off values. The final model included sex, maternal educational level, pre-existing maternal obesity, several milestones (smiling, speaking 2–3 word sentences, standing) and weight for height z score at age 1. The fit was good, and the discriminative performance was high (AUC: 0.837). Sensitivity and specificity were 73% and 80% at a cut-off probability of 10%. Our model is promising for use as a prediction tool in community-based settings. It could aid to identify infants in early life (age 2) with increased risk of future developmental problems at age 4 that may benefit from early interventions.
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Affiliation(s)
- Nienke H. van Dokkum
- Department of Pediatrics, Division of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands;
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands; (S.A.R.); (M.L.A.d.K.)
- Correspondence: ; Tel.: +31-50-361-4215; Fax: +31-50-361-4235
| | - Sijmen A. Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands; (S.A.R.); (M.L.A.d.K.)
| | - Martijn W. Heymans
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, location VU, University Medical Center, de Boelelaan 1089a, 1081HV Amsterdam, The Netherlands;
| | - Arend F. Bos
- Department of Pediatrics, Division of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands;
| | - Marlou L. A. de Kroon
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands; (S.A.R.); (M.L.A.d.K.)
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21
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Doi S, Fujiwara T, Isumi A. Association between maternal adverse childhood experiences and child's self-rated academic performance: Results from the K-CHILD study. CHILD ABUSE & NEGLECT 2020; 104:104478. [PMID: 32247070 DOI: 10.1016/j.chiabu.2020.104478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/10/2020] [Accepted: 03/18/2020] [Indexed: 05/17/2023]
Abstract
BACKGROUND Despite the number of studies showing the link between maternal adverse childhood experiences (ACEs) and offspring's neural development and mental health, little is known about the impacts of maternal ACEs on offspring's academic performance in the adolescent period. OBJECTIVE To examine the associations between maternal ACEs and self-rated academic performance in adolescent offspring. PARTICIPANTS AND SETTING Data from the population-based Kochi Child Health Impact of Living Difficulty (K-CHILD) study, conducted in 2016, was analyzed. Participants included 10,810 children in fifth grade, eighth grade, and eleventh grade living in Kochi prefecture, Japan, and data from maternal respondents were used (n = 7964). METHODS Maternal ACEs, childhood social economic status, current mental health, current socioeconomic status and maternal maltreatment of child were assessed by mothers. Self-rated academic performance was reported by children using a 5-point Likert scale. Ordinal logistic regression analyses were performed, which excluded children with lower self-esteem to avoid measurement bias on self-rated academic performance due to low self-esteem. RESULTS A higher number of maternal ACEs had a dose-response relationship with lower self-rated academic performance in adolescent offspring after adjusting for confounder (p trend <0.001). Specifically, adolescents of mothers who experienced parent loss were more likely to report lower self-rated academic performance (OR = 1.31; 95 %CI = 1.16-1.47), whereas adolescents of mothers who experienced maltreatment in childhood showed no association (OR = 1.10, 95 %CI = 0.99-1.22). CONCLUSIONS Maternal ACEs, and especially maternal parent loss, were associated with lower self-rated academic performance in adolescent offspring. Further study is needed to elucidate the possible mechanism underlying this association.
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Affiliation(s)
- Satomi Doi
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Aya Isumi
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan; Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo Japan
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22
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Marks KP. AAP Developmental Surveillance and Screening Algorithm Is Improved But Further Discussion Needed About 24 Months and 4 Years. Pediatrics 2020; 145:peds.2020-0712A. [PMID: 32471838 DOI: 10.1542/peds.2020-0712a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kevin P Marks
- Pediatrician and PhD student, PeaceHealth Medical Group
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23
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Zeraatkar D, Duku E, Bennett T, Guhn M, Forer B, Brownell M, Janus M. Socioeconomic gradient in the developmental health of Canadian children with disabilities at school entry: a cross-sectional study. BMJ Open 2020; 10:e032396. [PMID: 32350007 PMCID: PMC7213855 DOI: 10.1136/bmjopen-2019-032396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 02/27/2020] [Accepted: 04/07/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To examine the relationship between developmental health and neighbourhood socioeconomic status (SES) in kindergarten children with disabilities. DESIGN Cross-sectional study using population-level database of children's developmental health at school entry (2002-2014). SETTING 12 of 13 Canadian provinces/territories. MEASURES Taxfiler and Census data between 2005 and 2006, respectively, were aggregated according to custom-created neighbourhood boundaries and used to create an index of neighbourhood-level SES. Developmental health outcomes were measured for 29 520 children with disabilities using the Early Development Instrument (EDI), a teacher-completed measure of developmental health across five domains. ANALYSIS Hierarchical generalised linear models were used to test the association between neighbourhood-level SES and developmental health. RESULTS All EDI domains were positively correlated with the neighbourhood-level SES index. The strongest association was observed for the language and cognitive development domain (β (SE): 0.29 (0.02)) and the weakest association was observed for the emotional maturity domain (β (SE): 0.12 (0.01)). CONCLUSIONS The magnitude of differences observed in EDI scores across neighbourhoods at the 5th and 95th percentiles are similar to the effects of more established predictors of development, such as sex. The association of SES with developmental outcomes in this population may present a potential opportunity for policy interventions to improve immediate and long-term outcomes.
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Affiliation(s)
- Dena Zeraatkar
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Eric Duku
- Offord Centre for Child Studies, Department of Psychiatry and Behvioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Teresa Bennett
- Offord Centre for Child Studies, Department of Psychiatry and Behvioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Barry Forer
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behvioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Wallace ER, Ola C, Leroux BG, Speltz ML, Collett BR. Prediction of school-age IQ, academic achievement, and motor skills in children with positional plagiocephaly. Paediatr Child Health 2020; 26:e132-e137. [PMID: 33936342 DOI: 10.1093/pch/pxaa012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/20/2019] [Indexed: 11/14/2022] Open
Abstract
Introduction Children with positional plagiocephaly and/or brachycephaly (PPB) are at risk of early developmental delay, but little is known about early life factors associated with school-age neurodevelopment. This study examined associations of demographic characteristics, prenatal risk factors and early neurodevelopment assessment with school-age IQ, academic performance, and motor development in children with PPB. Methods The study sample consisted of 235 school-age children with PPB followed since infancy. Outcome measures included IQ using the Differential Ability Scales-Second Edition, academic achievement as measured by the Wechsler Individualized Achievement Tests-Third Edition), and motor function using the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition. Linear regression was used to examine the incremental improvement of model fit of demographics, prenatal and early life characteristics, severity of PPB, and neurodevelopment at ages 7, 18, and 36 months as measured by the Bayley-3 on school-age scores. Results Mean age at school-age assessment was 9.0 years. Adjusted r2 for demographic, prenatal, and early life risk factors ranged from 0.10 to 0.22. Addition of PPB severity and Bayley-3 measures at ages 7 and 18 months did not meaningfully change model fit. Adjusted r2 after inclusion of Bayley-3 at 36 months ranged from 0.35 to 0.41. Conclusion This study suggests that PPB severity and very early life neurodevelopment have little association with school-age neurodevelopment above and beyond demographic and early life risk factors. However, preschool-age neurodevelopmental assessment may still be useful in identifying children with PPB at risk for delay and who may benefit from early intervention.
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Affiliation(s)
- Erin R Wallace
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Cindy Ola
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Brian G Leroux
- Department of Biostatistics, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Matthew L Speltz
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Brent R Collett
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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25
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Taylor-Robinson D, Kee F. Precision public health-the Emperor's new clothes. Int J Epidemiol 2020; 48:1-6. [PMID: 30212875 PMCID: PMC6380317 DOI: 10.1093/ije/dyy184] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- David Taylor-Robinson
- Institute of Psychology, Health and Society, The Farr Institute@HeRC, University of Liverpool, Liverpool, UK
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health Research, Centre for Public Health, Queens University of Belfast, Belfast, UK
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26
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Dudovitz RN, Sim MS, Elashoff D, Klarin J, Slusser W, Chung PJ. Receipt of Corrective Lenses and Academic Performance of Low-Income Students. Acad Pediatr 2020; 20:910-916. [PMID: 31926990 PMCID: PMC7343614 DOI: 10.1016/j.acap.2020.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Untreated vision problems are associated with poor school performance. Whether providing glasses alone improves performance, however, remains unknown. We sought to test whether receiving glasses was associated with improved school performance for low-income minority students in Los Angeles. METHODS From 2017 to 2018, we analyzed achievement marks in mathematics and language arts from 406 first to fifth grade students attending 24 public elementary schools who received glasses through a free school-based vision program between February and May 2014, and 23,393 of their nonparticipating same-school, same-grade peers. We calculated students' percentile rank during each grading period in 1 year before and 2 years since they received glasses. Multilevel linear regressions tested whether percentile rank differed from baseline at each subsequent grading period. Models accounted for clustering at the school level and controlled for gender, grade level, and baseline class rank. Interaction terms tested whether associations differed by gender and class rank. RESULTS Students increased 4.5 percentile points (P = .02) in language arts in the second year after receiving glasses. There was no change in math achievement overall; however, those with baseline performance in the bottom tercile had an immediate and sustained improvement of 10 to 24 percentile points from baseline (interaction term P < .001). Class rank for behavior marks decreased during the fourth grading period after receiving glasses but subsequently returned to baseline. There were no significant changes in work habits and no variation in results by gender. CONCLUSIONS Ensuring access to vision care may be a simple, scalable strategy to improve language arts performance for low-income minority children.
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Affiliation(s)
- Rebecca N. Dudovitz
- Department of Pediatrics and Children’s Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital
| | - Myung Shin Sim
- General Internal Medicine and Health Services Research, UCLA
| | - David Elashoff
- General Internal Medicine and Health Services Research, UCLA
| | | | - Wendelin Slusser
- Department of Pediatrics and Children’s Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital,UCLA Fielding School of Public Health,UCLA Chancellor’s Office – Semel Healthy Campus Initiative Center at UCLA
| | - Paul J. Chung
- Department of Pediatrics and Children’s Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital,UCLA Fielding School of Public Health,RAND Health, RAND Corporation
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27
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Orr CJ, Chauvenet C, Ozgun H, Pamanes-Duran C, Flower KB. Caregivers' Experiences With Food Insecurity Screening and Impact of Food Insecurity Resources. Clin Pediatr (Phila) 2019; 58:1484-1492. [PMID: 31122058 DOI: 10.1177/0009922819850483] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We explored caregivers' experiences with food insecurity screening in a primary care setting and the impact of resources provided. English- and Spanish-speaking food insecure caregivers of children aged 1 to 5 years were recruited. In-depth individual semistructured interviews were conducted (n = 17) eliciting caregivers' experiences with food insecurity, clinic screening, and resources provided. Interviews were audio-recorded and transcribed verbatim. Interviews were double-coded and thematic analysis was used to identify themes and subthemes. All caregivers described multiple and repeat experiences with food insecurity. Food insecurity screening was acceptable, but families were not always connected with resources. Caregivers described WIC (Women, Infants, and Children) as the most commonly used program to address food insecurity and infrequently utilized other food insecurity resources. Screening for food insecurity in primary care was generally well accepted by this sample of food insecure caregivers. Future studies are needed to determine how to improve connecting resources with families most in need.
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Affiliation(s)
- Colin J Orr
- University of North Carolina at Chapel Hill, Chapel Hill NC, USA
| | | | - Holly Ozgun
- University of North Carolina at Chapel Hill, Chapel Hill NC, USA
| | | | - Kori B Flower
- University of North Carolina at Chapel Hill, Chapel Hill NC, USA
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28
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Rey-Casserly C, McGuinn L, Lavin A, LaMonte Askew G, Baum R, Berger-Jenkins E, Gambon TB, Nasir AA, Wissow LS, Weitzman CC, Blum NJ, Childers DO, Levine JM, Peralta-Carcelen AM, Poon JK, Smith PJ, Takayama JI, Voigt RG, Bridgemohan C. School-aged Children Who Are Not Progressing Academically: Considerations for Pediatricians. Pediatrics 2019; 144:peds.2019-2520. [PMID: 31548334 DOI: 10.1542/peds.2019-2520] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pediatricians and other pediatric primary care providers may be consulted when families have concerns that their child is not making expected progress in school. Pediatricians care not only for an increasingly diverse population of children who may have behavioral, psychological, and learning difficulties but also for increasing numbers of children with complex and chronic medical problems that can affect the development of the central nervous system and can present with learning and academic concerns. In many instances, pediatric providers require additional information about the nature of cognitive, psychosocial, and educational difficulties that affect their school-aged patients. Our purpose for this report is to describe the current state of the science regarding educational achievement to inform pediatricians' decisions regarding further evaluation of a child's challenges. In this report, we review commonly available options for psychological evaluation and/or treatment, medical referrals, and/or recommendations for referral for eligibility determinations at school and review strategies for collaborating with families, schools, and specialists to best serve children and families.
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Affiliation(s)
- Celiane Rey-Casserly
- Department of Psychiatry, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Laura McGuinn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, University of Alabama, Birmingham, and Children's of Alabama, Birmingham, Alabama; and
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29
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Camacho C, Straatmann VS, Day JC, Taylor-Robinson D. Development of a predictive risk model for school readiness at age 3 years using the UK Millennium Cohort Study. BMJ Open 2019; 9:e024851. [PMID: 31213442 PMCID: PMC6596936 DOI: 10.1136/bmjopen-2018-024851] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study is to develop a predictive risk model (PRM) for school readiness measured at age 3 years using perinatal and early infancy data. DESIGN AND PARTICIPANTS This paper describes the development of a PRM. Predictors were identified from the UK Millennium Cohort Study wave 1 data, collected when participants were 9 months old. The outcome was school readiness at age 3 years, measured by the Bracken School Readiness Assessment. Stepwise selection and dominance analysis were used to specify two models. The models were compared by the area under the receiver operating characteristic curve (AUROC) and integrated discrimination improvement (IDI). RESULTS Data were available for 9487 complete cases. At age 3, 11.7% (95% CI 11.0% to 12.3%) of children were not school ready. The variables identified were: parents' Socio-Economic Classification, child's ethnicity, maternal education, income band, sex, household number of children, mother's age, low birth weight, mother's mental health, infant developmental milestones, breastfeeding, parents' employment, housing type. A parsimonious model included the first six listed variables (model 2). The AUROC for model 1 was 0.80 (95% CI 0.78 to 0.81) and 0.78 (95% CI 0.77 to 0.79) for model 2. Model 1 resulted in a small improvement in discrimination (IDI=1.3%, p<0.001). CONCLUSIONS Perinatal and infant risk factors predicted school readiness at age three with good discrimination. Social determinants were strong predictors of school readiness. This study demonstrates that school readiness can be predicted by six attributes collected around the time of birth.
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Affiliation(s)
- Christine Camacho
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Viviane S Straatmann
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
- Aging Research Centre, Karolinska Institute, Stockholm, Sweden
| | - Jennie C Day
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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30
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Nelson BB, Thompson LR, Herrera P, Biely C, Arriola Zarate D, Aceves I, Estrada I, Chan V, Orantes C, Chung PJ. Telephone-Based Developmental Screening and Care Coordination Through 2-1-1: A Randomized Trial. Pediatrics 2019; 143:peds.2018-1064. [PMID: 30894408 PMCID: PMC6564070 DOI: 10.1542/peds.2018-1064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite professional guidelines to conduct universal early childhood developmental screening, primary care providers often struggle with early identification of developmental delays, referrals to interventions, and connecting families to services. In this study, we tested the efficacy of telephone-based developmental screening and care coordination through 2-1-1 Los Angeles County, which is part of a national network of call centers, compared with usual care alone. METHODS Children ages 12 to 42 months old who receive well-child care at a community health center serving predominantly Hispanic families were recruited and randomly assigned to intervention and control groups. Families in the intervention group were connected with 2-1-1, in which a trained care coordinator conducted developmental screening over the phone using the Parental Evaluation of Development Status Online system and made referrals to intervention services on the basis of developmental risk. The 2-1-1 care coordinator then followed-up with families to assist with connections to evaluations and services. After 6 months, primary outcomes included the following: (1) percentage of children referred for developmental evaluation and intervention services and (2) percentage of children actually receiving services. RESULTS One hundred and fifty-two children were randomly assigned to intervention (n = 77) and control (n = 75) groups. On the basis of intention-to-treat analyses, significantly more children assigned to the intervention group were referred (32% vs 9%; P = .001) and were receiving services (16% vs 1%; P = .002) within 6 months compared with children assigned to usual care alone. CONCLUSIONS Telephone-based developmental screening and care coordination through 2-1-1 appears to be an effective approach for increasing the numbers of young children referred to, and receiving, intervention services for developmental delays.
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Affiliation(s)
- Bergen B. Nelson
- Children’s Hospital of Richmond at Virginia
Commonwealth University, Richmond, Virginia;,Department of Pediatrics, University of California,
Los Angeles Mattel Children’s Hospital and David Geffen School of
Medicine, University of California, Los Angeles, Los Angeles, California;,University of California, Los Angeles
Children’s Discovery and Innovation Institute, Los Angeles,
California
| | - Lindsey R. Thompson
- Department of Pediatrics, University of California,
Los Angeles Mattel Children’s Hospital and David Geffen School of
Medicine, University of California, Los Angeles, Los Angeles, California;,University of California, Los Angeles
Children’s Discovery and Innovation Institute, Los Angeles,
California
| | | | - Christopher Biely
- Department of Pediatrics, University of California,
Los Angeles Mattel Children’s Hospital and David Geffen School of
Medicine, University of California, Los Angeles, Los Angeles, California;,University of California, Los Angeles
Children’s Discovery and Innovation Institute, Los Angeles,
California
| | - Damaris Arriola Zarate
- Department of Pediatrics, University of California,
Los Angeles Mattel Children’s Hospital and David Geffen School of
Medicine, University of California, Los Angeles, Los Angeles, California;,University of California, Los Angeles
Children’s Discovery and Innovation Institute, Los Angeles,
California
| | - Irene Aceves
- 2-1-1 Los Angeles County, San Gabriel,
California
| | - Ingrid Estrada
- Clínica Monseñor Oscar A. Romero, Los
Angeles, California
| | - Vincent Chan
- Department of Pediatrics, University of California,
Los Angeles Mattel Children’s Hospital and David Geffen School of
Medicine, University of California, Los Angeles, Los Angeles, California
| | - Cynthia Orantes
- Department of Pediatrics, School of Medicine, Loma
Linda University, Loma Linda, California
| | - Paul J. Chung
- Department of Pediatrics, University of California,
Los Angeles Mattel Children’s Hospital and David Geffen School of
Medicine, University of California, Los Angeles, Los Angeles, California;,University of California, Los Angeles
Children’s Discovery and Innovation Institute, Los Angeles,
California;,RAND Corporation, Santa Monica, California; and,Department of Health Systems Science, Kaiser
Permanente School of Medicine, Pasadena, California
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31
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Glascoe FP, Gellasch P, Chen V. When Do Clinicians Decide to Screen Children for Mental Health-Behavioral-Developmental Delays/Disorders: Is it Time to Reconsider Policy Recommendations? J Pediatr 2019; 206:248-255. [PMID: 30314659 DOI: 10.1016/j.jpeds.2018.08.084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/01/2018] [Accepted: 08/31/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine at which ages providers choose to screen for mental, behavioral, and developmental disorder/delay (MBDD), and what they find; and which, if any, public and professional guidelines are most effective at identification. STUDY DESIGN Naturalistic retrospective cohort study of 215 general pediatric and family practice clinics within 24 US states involving 160 634 encounters during which MBDD screening tests were administered. RESULTS Almost all clinicians (96%) administered screens at ages targeted by the American Academy of Pediatrics (AAP), that is, 9, 18, 24, and/or 30 months of age, but also at younger and older ages: 57% opted to screen at ≥5 years of age. Of the 8% of children at risk for probable MBDD, 27% were detected at American Academy of Pediatrics-targeted ages-71% across the birth to 5-year age range and an additional 29% at ≥5 years of age. Children >30 months of age were 3 times more likely to have probable MBDD than were younger children, and those >5 years of age were almost 4 times more likely to have probable MBDD. Older children were more likely to have psychosocial risk factors, but age itself was the most powerful predictor. CONCLUSIONS Most clinicians preferred to screen across the birth to 8-year age range and their findings revealed that most MBDDs cannot be detected in the earliest years of life. Policies regarding the timing of screening should be expanded to include all well visits and between visits if needed.
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Affiliation(s)
- Frances Page Glascoe
- Department of Pediatrics, Division of Child Development, Vanderbilt University, Nashville, TN.
| | - Patricia Gellasch
- Scientific Director/Medical Director, Gellasch Medical Associates, Hamilton, NJ
| | - Victoria Chen
- Department of Pediatrics, Division of Developmental/Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center, Lake Success, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
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32
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The Efficacy of Using Peer Mentors to Improve Maternal and Infant Health Outcomes in Hispanic Families: Findings from a Randomized Clinical Trial. Matern Child Health J 2018; 22:92-104. [PMID: 29855840 PMCID: PMC6153763 DOI: 10.1007/s10995-018-2532-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction The Maternal Infant Health Outreach Worker (MIHOW) program is a home visiting program, utilizing peer mentors to improve maternal/child health outcomes in underserved communities. Findings are presented from a randomized clinical trial (RCT) testing the efficacy of the MIHOW model in a sample of Hispanic women in Tennessee. We hypothesized maternal and infant outcomes would be better in women assigned to MIHOW than women assigned to the minimal education intervention (MEI) group (receipt of educational materials). Methods Women entered the study during pregnancy (< 26 weeks gestation) and were followed through 6 months postpartum. A total of 188 women were enrolled and randomly assigned (MEI = 94; MIHOW = 94), with 178 women completing the study (MEI = 87; MIHOW = 91). Results Positive and statistically significant (p < 0.01) effects of MIHOW were observed on breastfeeding self-efficacy and exclusivity, levels of depressive symptoms and parenting stress, safe sleep practices, and infant stimulation in the home. No statistically significant differences were noted in number of prenatal visits. Discussion Results expand limited empiric evidence and provide strong support of the effectiveness of MIHOW on improving health outcomes in this sample of Hispanic mothers and their infants. MIHOW is a viable option for providing culturally sensitive services to immigrant and underserved families.
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Tan ML, Laraia B, Madsen KA, Au LE, Frongillo EA, Ritchie LD. Child Food Insecurity Is Associated with Energy Intake among Fourth- and Fifth-Grade Girls. J Acad Nutr Diet 2018; 119:1722-1731.e2. [PMID: 30318250 DOI: 10.1016/j.jand.2018.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 07/11/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Food insecurity is associated with poor diet and obesity among adult women, but evidence among children is mixed, and few studies have examined differences between boys and girls. OBJECTIVE This study examined the relationship between self-reported food insecurity and dietary intake among boys and girls. DESIGN Cross-sectional survey data were used from the Children's PowerPlay! Campaign evaluation. PARTICIPANTS AND SETTING In all, 3,547 fourth- and fifth-grade students (9 to 11 years old) from 44 San Diego-area elementary schools in 2012 completed diary-assisted 24-hour recalls and a questionnaire that included five questions from the Child Food Security Assessment. MAIN OUTCOME MEASURES Individual dietary components (including total energy, nutrients, and sugar-sweetened beverages), Healthy Eating Index-2010 scores, and meal patterns (such as meal sizes and missed meals) were derived from 24-hour recalls. STATISTICAL ANALYSES Multivariable linear and logistic regression models were used to estimate the relationships between food insecurity and diet characteristics. RESULTS Girls with the highest food insecurity consumed 135 total kilocalories (P<0.005) and 60 snack kilocalories (P<0.05) more per day than girls with no food insecurity. These relationships were absent among boys. CONCLUSIONS Food insecurity among girls in grades 4 and 5 was associated with higher energy intake. Findings support the need for further research to better understand the nature of this relationship and its implications for energy balance.
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34
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Straatmann VS, Pearce A, Hope S, Barr B, Whitehead M, Law C, Taylor-Robinson D. How well can poor child health and development be predicted by data collected in early childhood? J Epidemiol Community Health 2018; 72:1132-1140. [PMID: 30242060 PMCID: PMC6252371 DOI: 10.1136/jech-2018-211028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/14/2018] [Accepted: 08/30/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Identifying children at risk of poor developmental outcomes remains a challenge, but is important for better targeting children who may benefit from additional support. We explored whether data routinely collected in early life predict which children will have language disability, overweight/obesity or behavioural problems in later childhood. METHODS We used data on 10 262 children from the UK Millennium Cohort Study (MCS) collected at 9 months, 3, and 11 years old. Outcomes assessed at age 11 years were language disability, overweight/obesity and socioemotional behavioural problems. We compared the discriminatory capacity of three models: (1) using data currently routinely collected around the time of birth; (2) Model 1 with additional data routinely collected at 3 years; (3) a statistically selected model developed using a larger set of early year's risk factors for later child health outcomes, available in the MCS-but not all routinely collected. RESULTS At age 11, 6.7% of children had language disability, 26.9% overweight/obesity and 8.2% socioemotional behavioural problems. Model discrimination for language disability was moderate in all three models (area under the curve receiver-operator characteristic 0.71, 0.74 and 0.76, respectively). For overweight/obesity, it was poor in model 1 (0.66) and moderate for model 2 (0.73) and model 3 (0.73). Socioemotional behavioural problems were also identified with moderate discrimination in all models (0.71; 0.77; 0.79, respectively). CONCLUSION Language disability, socioemotional behavioural problems and overweight/obesity in UK children aged 11 years are common and can be predicted with moderate discrimination using data routinely collected in the first 3 years of life.
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Affiliation(s)
| | - Anna Pearce
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Steven Hope
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Benjamin Barr
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Margaret Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Catherine Law
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
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35
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Iyer SN, Dawson MZ, Sawyer MI, Abdullah N, Saju L, Needlman RD. Added Value of Early Literacy Screening in Preschool Children. Clin Pediatr (Phila) 2017; 56:959-963. [PMID: 28420261 DOI: 10.1177/0009922817702937] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Early Literacy Screener (ELS) is a brief screen for emergent literacy delays in 4- and 5-year-olds. Standard developmental screens may also flag these children. What is the value of adding the ELS? Parents of children aged 4 (n = 45) and 5 (n = 26) years completed the Ages and Stages Questionnaire-3 (ASQ-3), the Survey of Well-Being in Young Children (SWYC), and the ELS. Rates of positive agreement (PA), negative agreement (NA), and overall agreement (Cohen's κ) across the various screening tools were calculated. Early literacy delays were detected in 51% of those who passed the ASQ and 38% of those who passed the SWYC. For ELS versus ASQ, κ = 0.18, PA = 0.36 (95% CI = 0.23-0.51), and NA = 0.83 (95% CI = 0.66-0.92). For ELS versus SWYC, κ = 0.42, PA = 0.61 (95% CI = 0.45-0.75), and NA = 0.82 (95% CI = 0.65-0.92). The ELS adds value by flagging early literacy delays in many children who pass either the ASQ-3 or SWYC.
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Affiliation(s)
| | - M Zachary Dawson
- 2 MetroHealth Chester Summer Scholars Program, Cleveland, OH, USA
| | | | | | - Leya Saju
- 4 MetroHealth Medical Center, Cleveland, OH, USA
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36
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Affiliation(s)
- Oskar G Jenni
- Child Development Center and the Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
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37
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Mascarenhas SS, Moorakonda R, Agarwal P, Lim SB, Sensaki S, Chong YS, Allen JC, Daniel LM. Characteristics and influence of home literacy environment in early childhood-centered literacy orientation. PROCEEDINGS OF SINGAPORE HEALTHCARE 2016. [DOI: 10.1177/2010105816674738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The home literacy environment (HLE) and joint parent–child book reading are key factors in children’s language and literacy acquisition. Child-centered literacy orientation (CCLO) refers to the child’s level of engagement in literacy events. Aim: To describe the HLE and identify demographic and HLE variables associated with a poor CCLO at 12 months of age. Methods: Parents of Singaporean children enrolled in the Growing Up in Singapore Towards healthy Outcomes (GUSTO; n = 1152, birth cohort 2009–2010) completed a childhood literacy questionnaire at 12 months to obtain scores on HLE (0–17) and CCLO (0–6). Logistic regression analyses were employed to identify predictors of low CCLO. Results: Parents of 525 children completed the questionnaire. Mothers were the main caregivers in half the households. Mandarin was the main language (34%). Majority of the respondents had a library card that was used less than weekly, and had fewer than 10 children’s books. 18% of parents read to the child daily, of whom one-quarter read at bedtime. Amongst half of the families who had a CCLO score of 0, two-thirds had the lowest HLE scores (0–2). Correlational analyses indicated significant association between HLE with CCLO at 12 months ( p < 0.001). Non-English speaking caregivers and mothers who had only completed primary education were at high risk of a poor 12-month CCLO. Conclusion: A literacy-rich home environment is associated with 12-month child-centered literacy orientation. Pediatricians and early years’ professionals may be able to promote benefits of literacy related activities to families at risk of poor child-centered literacy orientation.
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Affiliation(s)
- Sandra Sylvia Mascarenhas
- Department of Child Development, KK Women’s & Children’s Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | - Rajesh Moorakonda
- Duke-NUS Graduate Medical School, Singapore
- Singapore Clinical Research Institute, Singapore
| | - Pratibha Agarwal
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore
| | - Sok Bee Lim
- Department of Child Development, KK Women’s & Children’s Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
- Yong Loo Lin School of Medicine, Singapore
| | | | - Yap Seng Chong
- Yong Loo Lin School of Medicine, Singapore
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore
| | | | - Lourdes Mary Daniel
- Department of Child Development, KK Women’s & Children’s Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
- Yong Loo Lin School of Medicine, Singapore
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