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Ettinger de Cuba S, Bovell-Ammon A, Ahmad N, Bruce C, Poblacion A, Rateau LJ, Coleman SM, Black MM, Frank DA, Lê-Scherban F, Henchy G, Ochoa E, Sandel M, Cutts DB. Child Care Feeding Programs Associated With Food Security and Health for Young Children From Families With Low Incomes. J Acad Nutr Diet 2023; 123:1429-1439. [PMID: 37302653 DOI: 10.1016/j.jand.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND The Child and Adult Care Food Program is the primary national program that enables child-care settings to provide healthy meals for children. Associations between Child and Adult Care Food Program participation and child health and development and health care utilization are understudied. OBJECTIVE To assess associations between children's health, development, health care utilization and food security by meal source (child-care-provided vs parent-provided) among children from low-income families with a child care subsidy attending child-care in settings likely eligible to participate in Child and Adult Care Food Programs. DESIGN The study used repeat cross-sectional surveys (new sample at successive time points) conducted year-round. PARTICIPANTS AND SETTING Primary caregivers of 3,084 young children accessing emergency departments or primary care in Baltimore, MD; Boston, MA; Little Rock, AR; Minneapolis, MN; and Philadelphia, PA, were interviewed between 2010 and 2020. The sample was limited to children aged 13 to 48 months, receiving a child care subsidy and attending child-care centers or family child-care homes ≥20 hours per week. MAIN OUTCOME MEASURES Outcomes included household and child food security; child health, growth, and developmental risk; and admission to the hospital on the day of the emergency department visit. STATISTICAL ANALYSES Meal source and participant characteristics were analyzed using χ2 tests; associations of outcomes with parent-provided meals were analyzed with adjusted logistic regression. RESULTS The majority of children had child-care-provided meals (87.2% child-care-provided vs 12.8% parent-provided). Compared with children with parent-provided meals, children with child-care-provided meals had lower adjusted odds of living in a food-insecure household (adjusted odds ratio 0.70, 95% CI 0.55 to 0.88), being in fair or poor health (adjusted odds ratio 0.61, 95% CI 0.46 to 0.81), or hospital admission from the emergency department (adjusted odds ratio 0.59, 95% CI 0.41 to 0.83), with no differences in growth or developmental risk. CONCLUSIONS Compared with meals provided from home, child-care-provided meals likely supported by the Child and Adult Care Food Program are related to food security, early childhood health, and reduced hospital admissions from an emergency department among low-income families with young children.
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Affiliation(s)
- Stephanie Ettinger de Cuba
- Children's HealthWatch, Boston Medical Center, Boston, Massachusetts; Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts; Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts.
| | | | - Nayab Ahmad
- Children's HealthWatch, Boston Medical Center, Boston, Massachusetts
| | - Charlotte Bruce
- Children's HealthWatch, Boston Medical Center, Boston, Massachusetts
| | - Ana Poblacion
- Children's HealthWatch, Boston Medical Center, Boston, Massachusetts
| | - Lindsey J Rateau
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Sharon M Coleman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, (6)RTI International, Research Triangle Park, North Carolina
| | - Deborah A Frank
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Félice Lê-Scherban
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania; Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | | | - Eduardo Ochoa
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Megan Sandel
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Diana B Cutts
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota
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Poblacion A, Ettinger de Cuba S, Frank DA, Esteves G, Rateau LJ, Heeren TC, Coleman S, Black MM, Cutts DB, Lê-Scherban F, Ochoa ER, Sandel M, Sheward R, Cook J. Development and Validation of an Abbreviated Child and Adult Food Security Scale for Use in Clinical and Research Settings in the United States. J Acad Nutr Diet 2023; 123:S89-S102.e4. [PMID: 37730309 DOI: 10.1016/j.jand.2023.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/05/2022] [Accepted: 02/06/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Food insecurity (FI) prevalence was consistently >10% over the past 20 years, indicating chronic economic hardship. Recession periods exacerbate already high prevalence of FI, reflecting acute economic hardship. To monitor FI and respond quickly to changes in prevalence, an abbreviated food security scale measuring presence and severity of household FI in adults and children is needed. OBJECTIVE Our aim was to develop an abbreviated, sensitive, specific, and valid food security scale to identify severity levels of FI in households with children. DESIGN Cross-sectional and longitudinal survey data were analyzed for years 1998 to 2022. PARTICIPANTS/SETTING Participants were racially diverse primary caregivers of 69,040 index children younger than 4 years accessing health care in 5 US cities. STATISTICAL ANALYSES PERFORMED Sensitivity, specificity, positive and negative predictive values, accuracy, and area under the receiver operator curve were used to test combinations of questions for the most effective abbreviated scale to assess levels of severity of adult and child FI compared with the Household Food Security Survey Module. Adjusted logistic regression models assessed convergent validity between the Abbreviated Child and Adult Food Security Scale (ACAFSS) and health measures. McNemar tests examined the ACAFSS performance in times of acute economic hardship. RESULTS The ACAFSS exhibited 91.2% sensitivity; 99.6% specificity; 98.3% and 97.6% positive and negative predictive values, respectively; 97.7% accuracy; and a 99.6% area under the receiver operator curve, while showing high convergent validity. CONCLUSIONS The ACAFSS is highly sensitive, specific, and valid for detecting severity levels of FI among racially diverse households with children. The ACAFSS is recommended as a stand-alone scale or a follow-up scale after households with children screen positive for FI risk. The ACAFSS is also recommended for planning interventions and evaluating their effects not only on the binary categories of food security and FI, but also on changes in levels of severity, especially when rapid decision making is crucial.
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Affiliation(s)
- Ana Poblacion
- Department of Pediatrics, Children's HealthWatch, Boston Medical Center, Boston, Massachusetts.
| | - Stephanie Ettinger de Cuba
- Department of Pediatrics, Children's HealthWatch, Boston Medical Center, Boston, Massachusetts; Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Deborah A Frank
- Department of Pediatrics, Children's HealthWatch, Boston Medical Center, Boston, Massachusetts; Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | | | - Lindsey J Rateau
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Sharon Coleman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Maureen M Black
- Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, Baltimore, Maryland; RTI International, Research Triangle Park, North Carolina
| | - Diana B Cutts
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Félice Lê-Scherban
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Eduardo R Ochoa
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Megan Sandel
- Children's HealthWatch, Boston Medical Center, Boston, Massachusetts; Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Richard Sheward
- Children's HealthWatch, Boston Medical Center, Boston, Massachusetts
| | - John Cook
- Department of Pediatrics, Children's HealthWatch, Boston Medical Center, Boston, Massachusetts; Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
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Lê-Scherban F, Ettinger de Cuba S, Bovell-Ammon A, Coleman S, Rateau L, Cutts D, Black M, Heeren T, Frank DA. Association Between Material Hardship in Families With Young Children and Federal Relief Program Participation by Race and Ethnicity and Maternal Nativity. JAMA Health Forum 2023; 4:e230508. [PMID: 37083823 PMCID: PMC10122179 DOI: 10.1001/jamahealthforum.2023.0508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Importance Even brief periods of hardship during early childhood may have lifelong consequences. Prior cross-sectional research limited to respondents with English proficiency and internet access during the COVID-19 crisis documented families with young children that struggled to afford basic needs like food and rent. Few studies have examined experiences of families with young children by race and ethnicity and maternal nativity. Objective To examine the association of COVID-19 relief programs with the mitigation of household food insecurity among families with young children, as well as being behind on rent and disparities in program receipt. Design, Setting, and Participants This cohort study used data from the ongoing repeat cross-sectional Children's HealthWatch study comprising families surveyed at baseline (January 1, 2018, to March 20, 2020) and during the COVID-19 crisis (September 1, 2020, to June 30, 2021). Baseline questionnaires were administered face to face to caregivers of children aged 48 months or younger in English or Spanish in emergency departments or primary care clinics in 5 US cities. The follow-up questionnaires were administered via telephone. Exposures Supplemental Nutrition Assistance Program (SNAP) participation or receipt of at least 1 Economic Impact Payment (EIP; ie, stimulus check) during the COVID-19 crisis. Main Outcomes and Measures The primary outcomes were household food insecurity (assessed via the US Household Food Security Survey Module: Six-Item Short Form) and being behind on rent. Logistic and binomial regression models were used to calculate adjusted odds ratios (aORs) and unadjusted and adjusted prevalence ratios (PRs). Results Of 1396 caregiver-child dyads (20.3% response rate), race and ethnicity data were available for 1357 caregivers: 514 (37.9%) were Black, non-Latino; 558 (41.1%) were Latino; 230 (16.9%) were White, non-Latino; and 55 (4.1%) were of other non-Latino race or ethnicity. Among 1390 responses with nonmissing data, 417 children (30.0%) had an immigrant mother, and among 1388 responses, 1238 (33.5%) were publicly insured. During the crisis, 467 of 1395 respondents (33.5%) reported household food insecurity, and 567 of 1391 respondents (40.8%) reported being behind on rent. Families with immigrant mothers had lower odds of EIP and SNAP participation than families with US-born mothers (eg, aOR, 0.07 [95% CI, 0.05-0.12] for both EIP and SNAP vs neither), despite being more likely to report household food insecurity (adjusted PR [aPR], 1.48 [95% CI, 1.28-1.71]) and being behind on rent (aPR, 1.14 [95% CI, 1.00-1.30]). Families with Black (unadjusted PR [uPR], 1.40 [95% CI, 1.08-1.82]) or Latino (uPR, 1.54 [95% CI, 1.19-1.98]) caregivers or caregivers of other race and ethnicity (uPR, 1.67 [1.12-2.49]) were also more likely than families with White, non-Latino caregivers to experience household food insecurity or being behind on rent (families with Black caregivers: uPR, 2.02 [95% CI, 1.58-2.58]; families with Latino caregivers: 1.68 [95% CI, 1.30-2.16]; families with caregivers of other race or ethnicity: uPR, 1.94 [95% CI, 1.34-2.80]). Adjustment for covariates and differential participation in relief programs did not entirely account for these disparities. Conclusions and Relevance The results of this cohort study suggest that the COVID-19 crisis exacerbated preexisting inequities in food insecurity and difficulty paying rent according to race and ethnicity and maternal nativity and that equity-focused policy changes are needed to ensure that all children and their families in the US can afford basic needs for optimal health.
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Affiliation(s)
- Félice Lê-Scherban
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Stephanie Ettinger de Cuba
- Boston University School of Public Health, Boston, Massachusetts
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Allison Bovell-Ammon
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Sharon Coleman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Lindsey Rateau
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Diana Cutts
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Maureen Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
- RTI International, Research Triangle Park, North Carolina
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health
| | - Deborah A Frank
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
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Bovell-Ammon A, Ettinger de Cuba S, Lê-Scherban F, Rateau L, Heeren T, Cantave C, Green KA, Frank DA, Cutts D, Ochoa E, Sandel M. Changes in Economic Hardships Arising During the COVID-19 Pandemic: Differences by Nativity and Race. J Immigr Minor Health 2023; 25:483-488. [PMID: 36334182 PMCID: PMC9638452 DOI: 10.1007/s10903-022-01410-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/08/2022]
Abstract
Hardships in early childhood impact health. Few longitudinal studies have examined pandemic-related hardships among families with young children by race/ethnicity or nativity. We used prospective longitudinal data from 1,165 caregivers of children < 4 years surveyed in English and Spanish face-to-face in 5 urban hospitals 1/2018 to 3/2020 (pre-pandemic) and again by telephone 9/2020 to 3/2021 (during pandemic). Caregivers reported hardships (household food insecurity [HFI], child food insecurity [CFI]), behind on rent [BOR]) and maternal race/ethnicity and nativity. During the pandemic vs pre-pandemic, families with immigrant mothers had greater increases in HFI [aOR = 2.15 (CI 1.49-3.09)] than families with US-born mothers [aOR = 1.44 (CI 1.09-1.90)] and greater increases in BOR [families with immigrant mothers aOR = 4.09 (CI 2.78-6.01) vs. families with US-born mothers aOR = 2.19 (CI 1.68-2.85)]. CFI increases for all groups did not vary by nativity nor race/ethnicity. HFI and BOR increases during COVID were significantly greater in families with Latina mothers and those with immigrant mothers than other groups.
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Affiliation(s)
| | | | - Félice Lê-Scherban
- Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Lindsey Rateau
- School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston University, Boston, MA, USA
| | - Timothy Heeren
- School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston University, Boston, MA, USA
| | - Cerlyn Cantave
- Boston Medical Center, 801 Albany Street, Boston, MA, 02119, USA
| | - Kaye-Alese Green
- Boston University School of Public Health, Boston University School of Medicine, Boston, MA, USA
| | - Deborah A Frank
- Boston University School of Public Health, Boston University School of Medicine, Boston, MA, USA
| | - Diana Cutts
- Hennepin County Medical Center, Minneapolis, MN, USA
| | - Eduardo Ochoa
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Megan Sandel
- Boston Medical Center, 801 Albany Street, Boston, MA, 02119, USA.,Boston University School of Public Health, Boston University School of Medicine, Boston, MA, USA
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5
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Parker MG, de Cuba SE, Rateau LJ, Shea M, Sandel MT, Frank DA, Cutts DB, Heeren T, Lê-Scherban F, Black MM, Ochoa ER, Rose-Jacobs R, Garg A. Associations of household unmet basic needs and health outcomes among very low birth weight children. J Perinatol 2023; 43:364-370. [PMID: 36750715 DOI: 10.1038/s41372-023-01626-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 09/15/2022] [Accepted: 01/24/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE We examined associations of past year household hardships (housing, energy, food, and healthcare hardships) with postnatal growth, developmental risk, health status, and hospitalization among children 0-36 months born with very low birth weight (VLBW) and the extent that these relationships differed by receipt of child supplemental security income (SSI). STUDY DESIGN We examined cross-sectional data from 695 families. Growth was measured as weight-for-age z-score change. Developmental risk was defined as ≥1 concerns on the "Parents' Evaluation of Developmental Status" screening tool. Child health status was categorized as excellent/good vs. fair/poor. Hospitalizations excluded birth hospitalizations. RESULTS Compared to children with no household hardships, odds of developmental risk were greater with 1 hardship (aOR 2.0 [1.26, 3.17]) and ≥2 hardships (aOR) 1.85 [1.18, 2.91], and odds of fair/poor child health (aOR) 1.59 [1.02, 2.49] and hospitalizations (aOR) 1.49 [1.00, 2.20] were greater among children with ≥2 hardships. In stratified analysis, associations of hardships and developmental risk were present for households with no child SSI and absent for households with child SSI. CONCLUSION Household hardships were associated with developmental risk, fair/poor health status, and hospitalizations among VLBW children. Child SSI may be protective against developmental risk among children living in households with hardships.
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Affiliation(s)
- Margaret G Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
| | | | - Lindsey J Rateau
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Margaret Shea
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Megan T Sandel
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Deborah A Frank
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Diana B Cutts
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Félice Lê-Scherban
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.,RTI International, Research Triangel Park, NC, USA
| | - Eduardo R Ochoa
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ruth Rose-Jacobs
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
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Cutts DB, Ettinger de Cuba S, Bovell-Ammon A, Wellington C, Coleman SM, Frank DA, Black MM, Ochoa E, Chilton M, Lê-Scherban F, Heeren T, Rateau LJ, Sandel M. Eviction and Household Health and Hardships in Families With Very Young Children. Pediatrics 2022; 150:189509. [PMID: 36120757 DOI: 10.1542/peds.2022-056692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Families with versus without children are at greater eviction risk. Eviction is a perinatal, pediatric, and adult health concern. Most studies evaluate only formal evictions. METHODS Using cross-sectional surveys of 26 441 caregiver or young child (<48 months) dyads from 2011 to 2019 in emergency departments (EDs) and primary care clinics, we investigated relationships of 5 year history of formal (court-involved) and informal (not court-involved) evictions with caregiver and child health, history of hospitalizations, hospital admission from the ED on the day of the interview, and housing-related and other material hardships. RESULTS 3.9% of 26 441 caregivers reported 5 year eviction history (eviction), of which 57.0% were formal evictions. After controlling for covariates, we found associations were minimally different between formal versus informal evictions and were, therefore, combined. Compared to no evictions, evictions were associated with 1.43 (95% CI: 1.17-1.73), 1.55 (95% confidence interval [CI]: 1.32-1.82), and 1.24 (95% CI: 1.01-1.53) times greater odds of child fair or poor health, developmental risk, and hospital admission from the ED, respectively, as well as adverse caregiver and hardship outcomes. Adjusting separately for household income and for housing-related hardships in sensitivity analyses did not significantly alter results, although odds ratios were attenuated. Hospital admission from the ED was no longer significant. CONCLUSIONS Demonstrated associations between eviction and health and hardships support broad initiatives, such as housing-specific policies, income-focused benefits, and social determinants of health screening and community connections in health care settings. Such multifaceted efforts may decrease formal and informal eviction incidence and mitigate potential harmful associations for very young children and their families.
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Affiliation(s)
- Diana B Cutts
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota
| | | | | | - Chevaughn Wellington
- Children's HealthWatch, Boston Medical Center, Boston, Massachusetts.,Frank H. Netter M.D. School of Medicine, Quinnipiac University, North Haven, Connecticut
| | - Sharon M Coleman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Deborah A Frank
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Maureen M Black
- Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, Baltimore, Maryland.,RTI International, Research Triangle Park, North Carolina
| | - Eduardo Ochoa
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Félice Lê-Scherban
- Epidemiology and Biostatistics.,Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Timothy Heeren
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Lindsey J Rateau
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Megan Sandel
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
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7
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Parker MG, de Cuba SE, Rateau LJ, Sandel MT, Frank DA, Cutts DB, Heeren TC, Lê-Scherban F, Black MM, Ochoa ER, Garg A. Household unmet basic needs in the first 1000 days and preterm birth status. J Perinatol 2022; 42:389-396. [PMID: 35102255 DOI: 10.1038/s41372-022-01325-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/13/2021] [Accepted: 01/19/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To examine the relationship of individual and composite number of unmet basic needs (housing, energy, food, and healthcare hardships) in the past year with preterm birth status among children aged 0-24 months. STUDY DESIGN We examined cross-sectional 2011-18 data of 17,926 families with children aged 0-24 months. We examined children born <31 weeks', 31-33 weeks', and 34-36 weeks' gestation versus term (≥37 weeks) using multivariable multinomial logistic regression. RESULTS At least 1 unmet basic need occurred among ≥60% of families with preterm children, compared to 56% of families with term children (p = 0.007). Compared to term, children born ≤30 weeks' had increased odds of healthcare hardships (aOR 1.28 [1.04, 1.56]) and children born 34-36 weeks' had increased odds of 1 (aOR 1.19 [1.05, 1.35]) and ≥2 unmet needs (aOR 1.15 [1.01, 1.31]). CONCLUSION Unmet basic needs were more common among families with preterm, compared to term children.
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Affiliation(s)
- Margaret G Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
| | | | - Lindsey J Rateau
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Megan T Sandel
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Deborah A Frank
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Diana B Cutts
- Department of Pediatrics, Hennepin County Medical Center, Boston, MA, USA
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Félice Lê-Scherban
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.,RTI International, Research Triangle Park, NC, USA
| | - Eduardo R Ochoa
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
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8
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Ettinger de Cuba S, Mbamalu M, Bovell-Ammon A, Black MM, Cutts DB, Lê-Scherban F, Coleman SM, Ochoa ER, Heeren TC, Poblacion A, Sandel M, Bruce C, Rateau LJ, Frank DA. Prenatal WIC is Associated with Increased Birthweight of Infants Born in the United States with Immigrant Mothers. J Acad Nutr Diet 2022; 122:1514-1524.e4. [DOI: 10.1016/j.jand.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
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9
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Tang MN, Adolphe S, Rogers SR, Frank DA. Failure to Thrive or Growth Faltering: Medical, Developmental/Behavioral, Nutritional, and Social Dimensions. Pediatr Rev 2021; 42:590-603. [PMID: 34725219 DOI: 10.1542/pir.2020-001883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Margot N Tang
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
| | - Soukaina Adolphe
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
| | | | - Deborah A Frank
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
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10
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Ettinger de Cuba S, Chilton M, Bovell-Ammon A, Knowles M, Coleman SM, Black MM, Cook JT, Cutts DB, Casey PH, Heeren TC, Frank DA. Loss Of SNAP Is Associated With Food Insecurity And Poor Health In Working Families With Young Children. Health Aff (Millwood) 2020; 38:765-773. [PMID: 31059367 DOI: 10.1377/hlthaff.2018.05265] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Supplemental Nutrition Assistance Program (SNAP) helps working families meet their nutritional needs. Families whose earned income increases in a given month may have their SNAP benefits abruptly reduced or cut off in the following month. Using sentinel sample data from 2007-15 for families with children younger than age four, we investigated how SNAP benefit reductions or cutoffs resulting from increased income were related to economic hardships (food and energy insecurity, unstable housing, forgone health and/or dental care, and health cost sacrifices) and to caregiver and child health. After we controlled for covariates, we found that the groups whose SNAP benefits were reduced or cut off had significantly increased odds of household and child food insecurity, compared to a group with consistent participation in SNAP. Reduced benefits were associated with 1.43 and 1.22 times greater odds of fair or poor caregiver and child health, respectively. Policy modifications to smooth changes in benefit levels as work incomes improve may protect working families with young children from increased food insecurity, poor health, and forgone care.
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Affiliation(s)
- Stephanie Ettinger de Cuba
- Stephanie Ettinger de Cuba ( ) is executive director of Children's HealthWatch in the Department of Pediatrics, Boston University School of Medicine, in Massachusetts
| | - Mariana Chilton
- Mariana Chilton is a professor of health management and policy at the Dornsife School of Public Health, Drexel University, in Philadelphia, Pennsylvania
| | - Allison Bovell-Ammon
- Allison Bovell-Ammon is deputy director of policy strategy at Children's HealthWatch in the Department of Pediatrics, Boston Medical Center, in Massachusetts
| | - Molly Knowles
- Molly Knowles is a clinical research coordinator in the Division of General Internal Medicine, Penn Center for Community Health Workers, Perelman School of Medicine, University of Pennsylvania, in Philadelphia
| | - Sharon M Coleman
- Sharon M. Coleman is a statistical analyst at the Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health
| | - Maureen M Black
- Maureen M. Black is a professor of pediatrics at the University of Maryland School of Medicine, in Baltimore, and distinguished fellow with RTI International in Research Triangle Park, North Carolina
| | - John T Cook
- John T. Cook is an associate professor of pediatrics at the Boston University School of Medicine
| | - Diana Becker Cutts
- Diana Becker Cutts is an associate professor of pediatrics at the Hennepin County Medical Center, in Minneapolis, Minnesota
| | - Patrick H Casey
- Patrick H. Casey is a professor of pediatrics at the University of Arkansas School of Medicine, in Little Rock
| | - Timothy C Heeren
- Timothy C. Heeren is a professor of biostatistics at the Boston University School of Public Health
| | - Deborah A Frank
- Deborah A. Frank is a professor of child health and well-being at the Boston University School of Medicine
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11
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Affiliation(s)
- Deborah A Frank
- Department of Pediatrics and .,Children's HealthWatch, Boston Medical Center, Boston, Massachusetts; and
| | - Charlotte Bruce
- Department of Pediatrics and.,Children's HealthWatch, Boston Medical Center, Boston, Massachusetts; and
| | - Eduardo Ochoa
- Children's HealthWatch, Boston Medical Center, Boston, Massachusetts; and.,Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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12
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Barthelemy OJ, Richardson MA, Heeren TC, Chen CA, Liebschutz JM, Forman LS, Cabral HJ, Frank DA, Rose-Jacobs R. Do Differences in Learning Performance Precede or Follow Initiation of Marijuana Use? J Stud Alcohol Drugs 2020. [PMID: 30807269 DOI: 10.15288/jsad.2019.80.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Studies examining cross-sectional associations between age at marijuana initiation and memory deficits yield mixed results. Because longitudinal data are sparse, controversy continues regarding whether these deficits reflect premorbid risk factors or sequelae of early marijuana initiation; here, we examine this question in a community sample followed since birth. METHOD Masked examiners administered four subtests of the Wide Range Assessment of Memory and Learning (WRAML/WRAML2) from childhood until young adulthood to 119 urban, predominantly African American participants. Multivariable generalized estimated equation models measured longitudinal trajectories of learning. Participants were grouped as never users (n = 26), later initiators (≥16 years old; n = 31), and earlier initiators of marijuana use (n = 62). RESULTS Marijuana onset groups did not significantly differ on WRAML scaled scores or IQ in childhood, nor did they differ on WRAML scaled scores in adolescence. On most WRAML2 subtests, these groups did not significantly differ in young adulthood after taking into account sex and childhood IQ. However, on Story Memory, later initiators attained higher scaled scores in young adulthood, even after including additional covariates of anxiety, depression, postsecondary education, past-month marijuana use, and past-week high-risk drinking. They showed a significantly more positive trajectory than never users that was driven by within-group improvement after adolescence. Earlier initiators showed within-group decline in Story Memory after adolescence. CONCLUSIONS Differences in learning following earlier initiation of marijuana use may not be solely attributable to premorbid deficits.
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Affiliation(s)
- Olivier J Barthelemy
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Mark A Richardson
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Clara A Chen
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Jane M Liebschutz
- Boston Medical Center, Boston, Massachusetts.,Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.,Division of General Internal Medicine, Center for Research in Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Leah S Forman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Deborah A Frank
- Boston Medical Center, Boston, Massachusetts.,Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Ruth Rose-Jacobs
- Boston Medical Center, Boston, Massachusetts.,Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
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13
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Tang MN, de Cuba SE, Coleman SM, Heeran T, Sandel M, Chilton M, Frank DA, Huh SY. Maternal Place of Birth, Socioeconomic Characteristics, and Child Health in US-Born Latinx Children in Boston. Acad Pediatr 2020; 20:225-233. [PMID: 31541703 PMCID: PMC7081477 DOI: 10.1016/j.acap.2019.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/10/2019] [Accepted: 09/14/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Among US-born children of Latina US (USB) and Latina foreign-born mothers (FBM), to determine whether 1) household and child characteristics differ; 2) child health outcomes differ; 3) these differences diminish for children of FBM with longer duration of residence in the United States; and 4) these differences can be explained by food insecurity (FI) or by Supplemental Nutrition Assistance Program (SNAP) participation. METHODS Cross-sectional survey of 2145 Latina mothers of publicly insured US-born children 0 to 48 months old in a Boston emergency department (ED) 2004 to 2013. Predictors were FBM versus USBM and duration of residence in the United States. Outcomes were mothers' report of child health, history of hospitalization, developmental risk, and hospital admission on the day of ED visit. Multivariable logistic regression adjusted for potential confounders and effect modification. RESULTS FBM versus USBM households had more household (31% vs 26%) and child (19% vs 11%) FI and lower SNAP participation (44% vs 67%). Children of FBM versus USBM were more likely to be reported in fair/poor versus good/excellent health (adjusted odds ratios 1.9, 95% confidence interval [1.4, 2.6]), with highest odds for children of FBM with shortest duration of residence, and to be admitted to the hospital on the day of the ED visit (adjusted odds ratios 1.7, 95% confidence interval [1.3, 2.2]). SNAP and FI did not fully explain these outcomes. CONCLUSION When providing care and creating public policies, clinicians and policymakers should consider higher rates of food insecurity, lower SNAP participation, and risk for poor health outcomes in Latinx children of FBM.
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Affiliation(s)
- Margot N. Tang
- Department of Pediatrics, Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, US
| | - Stephanie Ettinger de Cuba
- Department of Pediatrics, Boston University School of Medicine, Children’s HealthWatch, One Boston Medical Center Pl. Vose Hall, 4th floor, Boston, MA 02118, US
| | - Sharon M. Coleman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street, M921 Boston, MA 02118, US,Present address: EBSCO Information Services,10 Estes Street, Ipswich, MA 01938, US
| | - Timothy Heeran
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street, M921 Boston, MA 02118, US
| | - Megan Sandel
- Department of Pediatrics, Boston University School of Medicine, Children’s HealthWatch, One Boston Medical Center Pl. Vose Hall, 4th floor, Boston, MA 02118, US
| | - Mariana Chilton
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University School of Public Health, 3600 Market Street, 7th Floor, Philadelphia, PA 19104, US
| | - Deborah A. Frank
- Boston Medical Center, Dowling Ground, 771 Albany Street, Boston MA 02118, US
| | - Susanna Y. Huh
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, US,Department of Pediatrics, Harvard Medical School
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14
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Ettinger de Cuba SA, Bovell-Ammon AR, Cook JT, Coleman SM, Black MM, Chilton MM, Casey PH, Cutts DB, Heeren TC, Sandel MT, Sheward R, Frank DA. SNAP, Young Children's Health, and Family Food Security and Healthcare Access. Am J Prev Med 2019; 57:525-532. [PMID: 31542130 DOI: 10.1016/j.amepre.2019.04.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The Supplemental Nutrition Assistance Program (SNAP) is the largest nutrition assistance program in the U.S. This study's objective was to examine the associations between SNAP participation and young children's health and development, caregiver health, and family economic hardships. METHODS Cross-sectional data from 2006 to 2016 were analyzed in 2017 for families with children aged <3 years in 5 cities. Generalized estimating equations and logistic regression were used to evaluate the associations of SNAP participation with child and caregiver health outcomes and food insecurity, forgone health care, and health cost sacrifices. Nonparticipants that were likely to be eligible for SNAP were compared with SNAP participants and analyses adjusted for covariates including Consumer Price Index for food to control for site-specific food prices. RESULTS The adjusted odds of fair or poor child health status (AOR=0.92, 95% CI=0.86, 0.98), developmental risk (AOR=0.82, 95% CI=0.69, 0.96), underweight, and obesity in children were lower among SNAP participants than among nonparticipants. In addition, food insecurity in households and among children, and health cost sacrifices were lower among SNAP participants than among nonparticipants. CONCLUSIONS Participation in SNAP is associated with reduced household and child food insecurity, lower odds of poor health and growth and developmental risk among infants and toddlers, and reduced hardships because of healthcare costs for their families. Improved SNAP participation and increased SNAP benefits that match the regional cost of food may be effective preventive health strategies for promoting the well-being of families with young children.
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Affiliation(s)
| | | | - John T Cook
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Sharon M Coleman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Maureen M Black
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, Maryland; RTI International, Research Triangle Park, North Carolina
| | - Mariana M Chilton
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Patrick H Casey
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Diana B Cutts
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Megan T Sandel
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts; Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Richard Sheward
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Deborah A Frank
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts; Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
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15
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Drennen CR, Coleman SM, Ettinger de Cuba S, Frank DA, Chilton M, Cook JT, Cutts DB, Heeren T, Casey PH, Black MM. Food Insecurity, Health, and Development in Children Under Age Four Years. Pediatrics 2019; 144:peds.2019-0824. [PMID: 31501233 PMCID: PMC7599443 DOI: 10.1542/peds.2019-0824] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Food insecurity and pediatric obesity affect young children. We examine how food insecurity relates to obesity, underweight, stunting, health, and development among children <4 years of age. METHODS Caregivers of young children participated in a cross-sectional survey at medical centers in 5 US cities. Inclusion criteria were age of <48 months. Exclusion criteria were severely ill or injured and private health insurance. The Household Food Security Survey Module defined 3 exposure groups: food secure, household food insecure and child food secure, and household food insecure and child food insecure. Dependent measures were obesity (weight-age >90th percentile), underweight (weight-age <5th percentile), stunting (height/length-age <5th percentile), and caregiver-reported child health and developmental risk. Multivariable logistic regression analyses, adjusted for demographic confounders, maternal BMI, and food assistance program participation examined relations between exposure groups and dependent variables, with age-stratification: 0 to 12, 13 to 24, 25 to 36, and 37 to 48 months of age. RESULTS Within this multiethnic sample (N = 28 184 children, 50% non-Hispanic African American, 34% Hispanic, 14% non-Hispanic white), 27% were household food insecure. With 1 exception at 25 to 36 months, neither household nor child food insecurity were associated with obesity, underweight, or stunting, but both were associated with increased odds of fair or poor health and developmental risk at multiple ages. CONCLUSIONS Among children <4 years of age, food insecurity is associated with fair or poor health and developmental risk, not with anthropometry. Findings support American Academy of Pediatrics recommendations for food insecurity screening and referrals to help families cope with economic hardships and associated stressors.
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Affiliation(s)
| | - Sharon M. Coleman
- Biostatistics and Epidemiology Data Analytics Center and Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
| | | | - Deborah A. Frank
- Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Mariana Chilton
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - John T. Cook
- Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | | | - Timothy Heeren
- Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Patrick H. Casey
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Maureen M. Black
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, Maryland;,RTI International, Research Triangle Park, North Carolina
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16
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Rose-Jacobs R, Ettinger de Cuba S, Bovell-Ammon A, Black MM, Coleman SM, Cutts D, Chilton M, Heeren T, Casey P, Ochoa E, Frank DA, Sandel M. Housing Instability Among Families With Young Children With Special Health Care Needs. Pediatrics 2019; 144:peds.2018-1704. [PMID: 31292218 DOI: 10.1542/peds.2018-1704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Children with special health care needs (SHCNs) have significant medical and educational expenses affecting household finances. Housing instability can be detrimental to family well-being. Our objective was to evaluate housing instability in households of children with and without SHCNs. METHODS Cross-sectional surveys (2013-2017) in English and Spanish of caregivers with children <4 years old were conducted at 5 hospitals. The children with SHCN screener and caregiver report of child Supplemental Security Income (SSI) receipt were used to categorize children into the following groups: (1) no SHCNs, (2) SHCNs and no SSI, or (3) SHCNs and receiving SSI. Housing instability was determined by positive endorsement of ≥1 adverse circumstance: behind on rent or mortgage, or moving twice or more in the past year, or homelessness in the child's lifetime. Analyses used multivariable logistic regression models, adjusting for demographics and housing subsidies. RESULTS Of 14 188 children, 80% had no SHCNs, 16% had SHCNs and no SSI, and 4% had SHCNs and received SSI. Compared with the no-SHCNs group, the SHCNs-no-SSI group but not the SHCN-receiving-SSI group experienced significantly greater adjusted odds of being behind on rent or mortgage (adjusted odds ratio [aOR] 1.28 [95% confidence interval (CI) 1.14-1.44]; P < .001), multiple moves (aOR 1.29 [95% CI 1.05-1.59]; P = .01), and homelessness (aOR 1.44 [95% CI 1.20-1.72]; P < .001). CONCLUSIONS Families of children with SHCNs are at risk for housing instability. Child SSI receipt decreased the risk of housing instability among families of children with SHCNs. Protecting families of young children with SHCNs from housing instability is an important investment.
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Affiliation(s)
- Ruth Rose-Jacobs
- Department of Pediatrics, School of Medicine, and .,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | | | | | - Maureen M Black
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, Maryland.,RTI International, Durham, North Carolina
| | - Sharon M Coleman
- Biostatistics and Epidemiology Data Analytics Center, School of Public Health, Boston University, Boston, Massachusetts
| | - Diana Cutts
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Mariana Chilton
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania; and
| | | | - Patrick Casey
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Eduardo Ochoa
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Deborah A Frank
- Department of Pediatrics, School of Medicine, and.,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Megan Sandel
- Department of Pediatrics, School of Medicine, and.,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
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17
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Sandel M, Sheward R, Ettinger de Cuba S, Coleman S, Heeren T, Black MM, Casey PH, Chilton M, Cook J, Cutts DB, Rose-Jacobs R, Frank DA. Timing and Duration of Pre- and Postnatal Homelessness and the Health of Young Children. Pediatrics 2018; 142:peds.2017-4254. [PMID: 30177513 DOI: 10.1542/peds.2017-4254] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5804912861001PEDS-VA_2017-4254Video Abstract OBJECTIVES: Prenatal homelessness is associated with elevated risks of adverse neonatal outcomes. How the timing and duration of homelessness during pregnancy and/or a child's early life relate to postnatal child health is unclear. METHODS We interviewed 20 571 low-income caregivers of children <4 years old in urban pediatric clinics and/or emergency departments in 5 US cities. Categories of homelessness timing were prenatal, postnatal, both, or never; postnatal duration was >6 months or <6 months. RESULTS After controlling for birth outcomes and other potential confounders, compared with never-homeless children, children who were homeless both pre- and postnatally were at the highest risk of the following: postneonatal hospitalizations (adjusted odds ratio [aOR] 1.41; confidence interval [CI] 1.18-1.69), fair or poor child health (aOR 1.97; CI 1.58-2.47), and developmental delays (aOR 1.48; CI 1.16-1.89). There was no significant association with risk of underweight (aOR 0.95; CI 0.76-1.18) or overweight status (aOR 1.07; CI 0.84-1.37). Children <1 year old with >6 months of homelessness versus those who were never homeless had high risks of fair or poor health (aOR 3.13; CI 2.05-4.79); children 1 to 4 years old who were homeless for >6 months were at risk for fair or poor health (aOR 1.89; CI 1.38-2.58). CONCLUSIONS After controlling for birth outcomes, the stress of prenatal and postnatal homelessness was found to be associated with an increased risk of adverse pediatric health outcomes relative to those who were never homeless. Interventions to stabilize young families as quickly as possible in adequate and affordable housing may result in improved pediatric health outcomes.
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Affiliation(s)
- Megan Sandel
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts;
| | - Richard Sheward
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | | | | | - Timothy Heeren
- Department of Biostatistics, School of Public Health, and
| | - Maureen M Black
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Patrick H Casey
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mariana Chilton
- Department of Health Management and Policy, Dornfife School of Public Health, Drexel University, Philadelphia, Pennsylvania; and
| | - John Cook
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Diana Becker Cutts
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Ruth Rose-Jacobs
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Deborah A Frank
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
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Liebschutz JM, Buchanan-Howland K, Chen CA, Frank DA, Richardson MA, Heeren TC, Cabral HJ, Rose-Jacobs R. Childhood Trauma Questionnaire (CTQ) correlations with prospective violence assessment in a longitudinal cohort. Psychol Assess 2018; 30:841-845. [PMID: 29847987 PMCID: PMC5986087 DOI: 10.1037/pas0000549] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Retrospective recall-based measures administered to adults, like the Childhood Trauma Questionnaire (CTQ), are commonly used to determine experiences of childhood trauma in the home. However, the CTQ has not been compared with prospective measures of childhood violence exposure, whether at home or in the community. We evaluated the relationships between young adults' responses to the CTQ and their prospective self-reports of exposure to violence in childhood and adolescence. Participants were 127 (93% African American, 47% male) urban young adults in a longitudinal birth cohort study examining effects of prenatal substance exposure and environmental factors on development. Participants completed the Violence Exposure Scale for Children-Revised (VEX-R), a 21-item self-report measure of experience of/witness to interpersonal violence, administered face to face at 9, 10, and 11 years using cartoon pictures, and via audio-computer assisted self-interview at 12, 14, and 16 years. Participants also completed the CTQ, a 28-item, 5-scale screening measure, during a young-adult follow-up (ages 18-23). Using Pearson Correlation coefficients, VEX-R total scores significantly correlated with the sum of CTQ scales, r = .33, p < .01, and 3 (physical, emotional, and sexual abuse) of the 5 CTQ subscales, showing a moderate linear association. This study suggests that the CTQ serves as a reasonable retrospective assessment of prospectively ascertained childhood trauma exposure. The differences may be accounted for by disparities in domains assessed. (PsycINFO Database Record
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Affiliation(s)
- Jane M Liebschutz
- Boston University Schools of Medicine and Public Health, Boston University
| | | | - Clara A Chen
- Boston University Schools of Medicine and Public Health, Boston University
| | - Deborah A Frank
- Boston University Schools of Medicine and Public Health, Boston University
| | | | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston University
| | - Howard J Cabral
- Boston University Schools of Medicine and Public Health, Boston UniversityDepartment of Biostatistics, Boston University School of Public Health, Boston University
| | - Ruth Rose-Jacobs
- Department of Pediatrics, Boston University School of Medicine, Boston University
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Sandel M, Sheward R, Ettinger de Cuba S, Coleman SM, Frank DA, Chilton M, Black M, Heeren T, Pasquariello J, Casey P, Ochoa E, Cutts D. Unstable Housing and Caregiver and Child Health in Renter Families. Pediatrics 2018; 141:peds.2017-2199. [PMID: 29358482 DOI: 10.1542/peds.2017-2199] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate how 3 forms of housing instability relate to caregiver and child health among low-income renter households. METHODS Caregivers of children 0 to 48 months of age were interviewed in 5 urban medical centers from May 2009 to December 2015. Caregivers reported on the following: caregiver health, maternal depressive symptoms, child's health, lifetime hospitalizations, developmental risk, and 3 housing circumstances, which were categorized as being behind on rent in the past 12 months, multiple moves (≥ 2 in past 12 months), and child's lifetime history of homelessness. Associations with caregiver and child health outcomes were examined through multivariable logistic regression. RESULTS Of 22 324 families, 34% had at least 1 of the following adverse housing circumstances: 27% had been behind on rent, 8% had made multiple moves, and 12% had a history of being homeless. Overlap between these was limited; 86% experienced only 1 adverse housing circumstance. Each circumstance was individually associated with increased adjusted odds of adverse health and material hardship compared with stable housing. Households behind on rent had increased adjusted odds of fair and/or poor caregiver health (adjusted odds ratio [aOR]: 1.91; 95% confidence interval [CI]: 1.77-2.05), maternal depressive symptoms (aOR: 2.71; 95% CI: 2.51-2.93), child lifetime hospitalizations (aOR: 1.19; 95% CI: 1.10-1.27), fair and/or poor child health (aOR: 1.41; 95% CI: 1.28-1.56), and household material hardships. Families with multiple moves and history of homelessness had similar adverse caregiver, child, health, and hardship outcomes. CONCLUSIONS Three forms of housing instability were associated with adverse caregiver and child health among low-income renter households. The American Academy of Pediatrics recommends social screening within health care; providers could consider assessing for behind on rent, multiple moves, and homelessness in high-risk practices.
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Affiliation(s)
- Megan Sandel
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts;
| | - Richard Sheward
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Stephanie Ettinger de Cuba
- Data Coordinating Center and Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
| | - Sharon M Coleman
- Data Coordinating Center and Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
| | - Deborah A Frank
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Mariana Chilton
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Maureen Black
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Timothy Heeren
- Data Coordinating Center and Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
| | | | - Patrick Casey
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and
| | - Eduardo Ochoa
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and
| | - Diana Cutts
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota
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Sun J, Patel F, Rose-Jacobs R, Frank DA, Black MM, Chilton M. Mothers' Adverse Childhood Experiences and Their Young Children's Development. Am J Prev Med 2017; 53:882-891. [PMID: 28919342 DOI: 10.1016/j.amepre.2017.07.015] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 06/14/2017] [Accepted: 07/21/2017] [Indexed: 01/27/2023]
Abstract
INTRODUCTION This study examined how mothers' Adverse Childhood Experiences (ACEs) relate to their children's developmental risk and assessed how the association is mediated through mothers' depressive symptoms and fair/poor health. METHODS Mothers of children aged between 4 months and 4 years were recruited from the emergency department of a children's hospital between March 2012 and June 2015 and interviewed about ACEs, mothers' depressive symptoms and health status, and children's developmental risk (screened via Parents' Evaluations of Developmental Status [PEDS]). Between August and November 2016 a Cochran-Armitage test assessed trend of PEDS by ACEs. Multinomial regression models examined differences in PEDS by ACEs severity. Mediation by mothers' depressive symptoms and self-rated health was also assessed. RESULTS Of 1,293 mothers, 56.7% reported one or more ACEs. Mothers also reported developmental risk (20.4% overall): 120 (9.2%) reported one concern and 144 (11.2%) reported two or more concerns on the PEDS. Mothers who reported household substance use, mental illness, or an incarcerated household member during childhood were more likely to report at least one child developmental concern on the PEDS. After controlling for covariates, odds of one PEDS concern were 1.86 (95% CI=1.16, 3.00) for ACEs, one to three versus none, and 2.21 (95% CI=1.26, 3.87) for ACEs four or more versus none. Adjusted odds of two or more concerns were 1.70 (95% CI=1.07, 2.72) for ACEs, one to three versus none, and 1.76 (95% CI=1.02, 3.05) for ACEs, four or more versus none. Mothers' depressive symptoms and self-rated health were potential mediators. CONCLUSIONS Mothers' ACEs are significantly associated with their children's developmental risk. If replicated, findings suggest that addressing intergenerational trauma through focus on childhood adversity among young children's caregivers may promote child development.
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Affiliation(s)
- Jing Sun
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Falguni Patel
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Ruth Rose-Jacobs
- Boston University School of Medicine and Boston Medical Center Department of Pediatrics, Boston, Massachusetts
| | - Deborah A Frank
- Boston University School of Medicine and Boston Medical Center Department of Pediatrics, Boston, Massachusetts
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland; RTI International, Research Park, North Carolina
| | - Mariana Chilton
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania.
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Rose-Jacobs R, Richardson MA, Buchanan-Howland K, Chen CA, Cabral H, Heeren TC, Liebschutz J, Forman L, Frank DA. Intrauterine exposure to tobacco and executive functioning in high school. Drug Alcohol Depend 2017; 176:169-175. [PMID: 28544995 PMCID: PMC5539953 DOI: 10.1016/j.drugalcdep.2017.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 02/14/2017] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Executive functioning (EF), an umbrella construct encompassing gradual maturation of cognitive organization/management processes, is important to success in multiple settings including high school. Intrauterine tobacco exposure (IUTE) correlates with negative cognitive/behavioral outcomes, but little is known about its association with adolescent EF and information from real-life contexts is sparse. We evaluated the impact of IUTE on teacher-reported observations of EF in urban high school students controlling for covariates including other intrauterine and adolescent substance exposures. METHODS A prospective low-income birth cohort (51% male; 89% African American/Caribbean) was followed through late adolescence (16-18 years old). At birth, intrauterine exposures to cocaine and other substances (52% cocaine, 52% tobacco, 26% marijuana, 26% alcohol) were identified by meconium and/or urine assays, and/or maternal self-report. High school teachers knowledgeable about the student and unaware of study aims were asked to complete the Behavior Rating Inventory of Executive Functioning-Teacher Form (BRIEF-TF) annually. RESULTS Teachers completed at least one BRIEF-TF for 131 adolescents. Multivariable analyses included controls for: demographics; intrauterine cocaine, marijuana, and alcohol exposures; early childhood exposures to lead; and violence exposure from school-age to adolescence. IUTE was associated with less optimal BRIEF-TF Behavioral Regulation scores (p <0.05). Other intrauterine substance exposures did not predict less optimal BRIEF-TF scores, nor did exposures to violence, lead, nor adolescents' own substance use. CONCLUSIONS IUTE is associated with offspring's less optimal EF. Prenatal counseling should emphasize abstinence from tobacco, as well as alcohol and illegal substances.
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Affiliation(s)
- Ruth Rose-Jacobs
- Boston University School of Medicine, Department of Pediatrics, 72 East Concord St, Boston, MA 02118, United States; Boston Medical Center, Department of Pediatrics,1 Medical Center Place, Boston, MA, 02118, United States.
| | - Mark A Richardson
- Boston University, Department of Psychological & Brain Sciences,648 Beacon Street, Boston, MA, 02215, United States
| | - Kathryn Buchanan-Howland
- Boston Medical Center, Department of Pediatrics,1 Medical Center Place, Boston, MA, 02118, United States
| | - Clara A Chen
- Boston University School of Public Health, Data Coordinating Center, 85 East Newton Street, United States
| | - Howard Cabral
- Boston University School of Public Health, Department of Biostatistics, 715 Albany Street, Boston, MA 02118, United States
| | - Timothy C Heeren
- Boston University School of Public Health, Department of Biostatistics, 715 Albany Street, Boston, MA 02118, United States
| | - Jane Liebschutz
- Boston University School of Medicine, Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Avenue, Boston, MA 02118, United States
| | - Leah Forman
- Boston University School of Public Health, Data Coordinating Center, 85 East Newton Street, United States
| | - Deborah A Frank
- Boston University School of Medicine, Department of Pediatrics, 72 East Concord St, Boston, MA 02118, United States; Boston Medical Center, Department of Pediatrics,1 Medical Center Place, Boston, MA, 02118, United States
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Abstract
Research on the association between prenatal substance exposures and adaptive functioning among young adults is limited, with inconsistent conclusions. In a prospective longitudinal study of 138 urban young adults, prenatal substance exposures were identified at birth from maternal self-report, urine screens, and/or infant meconium. At follow-up between ages 18 and 24 years, masked interviewers assessed level of adaptive functioning, a composite indicator comprising five domains: education, housing, adolescent pregnancy, arrest history, and employment. A significant negative association was found between prenatal tobacco exposure and adaptive functioning, particularly among females with heavier exposure. This association with heavier, but not lighter, prenatal tobacco exposure is consistent with a neuroteratologic explanation, but other, non-biological explanations cannot be ruled out. No statistically significant associations were observed between prenatal cocaine, marijuana, or low-moderate alcohol exposure and young adult adaptive functioning.
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Derauf C, Katz AR, Frank DA, Grandinetti A, Easa D. The Prevalence of Methamphetamine and other Drug Use during Pregnancy in Hawaii. Journal of Drug Issues 2016. [DOI: 10.1177/002204260303300411] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Methamphetamine abuse is epidemic in Hawaii, but the extent of use among pregnant women is unknown. We sought to define the prevalence of use during pregnancy. We conducted a cross-sectional study of consecutive births between November and December 1999, and determined that the prevalence of drug metabolites in meconium were fatty acid ethyl esters: 72 (17.1%); cotinine: 33 (7.7%); opiates: 4 (0.9%); delta-9 tetrahydrocannabinal: 1 (0.2%); and methamphetamine: 3 (0.7%). Including three positives discovered solely through forensic testing, the overall prevalence of methamphetamine exposure during pregnancy was 1.4% (6/443). The prevalence of methamphetamine was low compared to the prevalence of fatty acid ethyl esters, reportedly indicative of ethanol exposure, and cotinine, a tobacco metabolite. In Hawaii, more attention should be directed towards alcohol and tobacco use during pregnancy.
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Barthelemy OJ, Richardson MA, Cabral HJ, Frank DA. Prenatal, perinatal, and adolescent exposure to marijuana: Relationships with aggressive behavior. Neurotoxicol Teratol 2016; 58:60-77. [PMID: 27345271 DOI: 10.1016/j.ntt.2016.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 05/25/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022]
Abstract
This manuscript reviews research exploring the relationship between prenatal, perinatal, and adolescent exposure to marijuana and aggressive behavior, including physical aggression. Areas of inquiry include animal research, as well as human research, on prenatal exposure and on marijuana use during adolescence. Potential psychosocial and psychopharmacological mechanisms are identified, as well as relevant confounds. The prenatal marijuana exposure literature provides minimal support for a direct relationship with aggressive behavior in childhood. The adolescent use literature suggests a marginal (at best) association between acute intoxication and aggressive behavior, and an association between chronic use and aggressive behavior heavily influenced by demographic variables, rather than direct, psychopharmacological mechanisms. Cannabis withdrawal symptoms also may include aggression and anger, but there is little evidence to suggest that these effects are large or specific to withdrawal from marijuana compared to other substances. This review will offer recommendations for clinical care and public policy, as well as important questions for future research.
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Affiliation(s)
- Olivier J Barthelemy
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, United States
| | - Mark A Richardson
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, United States; Division of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | - Deborah A Frank
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States.
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Barthelemy OJ, Richardson MA, Rose-Jacobs R, Forman LS, Cabral HJ, Frank DA. Effects of intrauterine substance and postnatal violence exposure on aggression in children. Aggress Behav 2016; 42:209-21. [PMID: 26660077 DOI: 10.1002/ab.21607] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 06/09/2015] [Accepted: 06/25/2015] [Indexed: 01/31/2023]
Abstract
During the cocaine epidemic of the 1980s and early 1990s, many expressed fears that children with intrauterine cocaine exposure (IUCE) would grow up to be unusually violent. The present study examines the relationship of caregiver reports of school-age children's aggressive behavior with IUCE and postnatal exposure to violence. Respondents were 140 low-income, primarily African American children, ages 8-11, and each child's current primary caregiver from a longitudinal study evaluating potential long term sequelae of IUCE. Multiple regression analyses were used to investigate the independent and interactive effects of level of IUCE (None (n = 69), Lighter (n = 47), Heavier (n = 24)) and exposure to violence (Violence Exposure Scale for Children-Revised) on aggressive behavior (Child Behavior Checklist), while also controlling for other intrauterine substance exposures and additional contextual factors. Children's self-reported exposure to violence was significantly positively associated with caregivers' reports of aggressive behavior (β = 2.17, P = .05), as was concurrent caregiver's psychiatric distress (β = .15, P = .003). However, neither IUCE nor its interaction with exposure to violence showed a significant association with aggressive behavior. Findings suggest the importance of postnatal social environment rather than IUCE in predicting aggressive behavior in childhood.
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Affiliation(s)
- Olivier J. Barthelemy
- Department of Psychological and Brain Sciences; Boston University; Boston Massachusetts
| | - Mark A. Richardson
- Department of Psychological and Brain Sciences; Boston University; Boston Massachusetts
- Division of Psychiatry; Boston University School of Medicine; Boston Massachusetts
| | - Ruth Rose-Jacobs
- Department of Pediatrics; Boston University School of Medicine; Boston Massachusetts
| | - Leah S. Forman
- Data Coordinating Center; Boston University School of Public Health; Boston Massachusetts
| | - Howard J. Cabral
- Department of Biostatistics; Boston University School of Public Health; Boston Massachusetts
| | - Deborah A. Frank
- Department of Pediatrics; Boston University School of Medicine; Boston Massachusetts
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Sun J, Knowles M, Patel F, Frank DA, Heeren TC, Chilton M. Childhood Adversity and Adult Reports of Food Insecurity Among Households With Children. Am J Prev Med 2016; 50:561-572. [PMID: 26596189 DOI: 10.1016/j.amepre.2015.09.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/25/2015] [Accepted: 09/25/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Exposure to childhood adversity, including abuse, neglect, and household dysfunction, is associated with negative long-term health and economic outcomes. Little is known about how adversity exposure in parents' early lives may be related to later food insecurity for parents and their children. This study investigated the association between female caregivers' adverse childhood experiences (ACEs) and household and child food insecurity, taking into account depressive symptoms. METHODS This study used cross-sectional data from 1,255 female caregivers of children aged <4 years surveyed in an urban clinical setting from March 2012 through June 2014. Measures included sociodemographic characteristics; caregivers' ACEs, including abuse, neglect, and household dysfunction; depressive symptoms; and household and child food insecurity. Multinomial and logistic regression analyses assessed the relationship among ACEs, depressive symptoms, and household and child food security status. RESULTS Caregiver depressive symptoms modified associations between ACEs and food insecurity level. After adjusting for covariates, caregivers reporting both depressive symptoms and four or more ACEs were 12.3 times as likely to report low food security (95% CI=6.2, 24.7); 28.8 times as likely to report very low food security (95% CI=12.8, 64.8); and 17.6 times as likely to report child food insecurity (95% CI=7.3, 42.6) compared with those reporting no depressive symptoms and no ACEs. CONCLUSIONS Depressive symptoms and ACEs were independently associated with household and child food insecurity, and depressive symptoms modified the association between ACEs and household and child food insecurity. Comprehensive policy interventions incorporating nutrition assistance and behavioral health may address intergenerational transmission of disadvantage.
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Affiliation(s)
- Jing Sun
- Department of Epidemiology, Drexel University School of Public Health, Philadelphia, Pennsylvania
| | - Molly Knowles
- Department of Health Management and Policy, Drexel University School of Public Health, Philadelphia, Pennsylvania
| | - Falguni Patel
- Department of Health Management and Policy, Drexel University School of Public Health, Philadelphia, Pennsylvania
| | - Deborah A Frank
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Mariana Chilton
- Department of Health Management and Policy, Drexel University School of Public Health, Philadelphia, Pennsylvania.
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Richardson MA, Grant-Knight W, Beeghly M, Rose-Jacobs R, Chen CA, Appugliese DP, Cabral HJ, Liebschutz JM, Frank DA. Psychological Distress Among School-Aged Children with and Without Intrauterine Cocaine Exposure: Perinatal Versus Contextual Effects. J Abnorm Child Psychol 2016; 44:547-60. [PMID: 26194603 PMCID: PMC4854523 DOI: 10.1007/s10802-015-0052-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Whether intrauterine cocaine exposure (IUCE) explains unique variance in psychiatric functioning among school age children, even after controlling for other biological and social risk factors, has not been fully delineated. As part of a longitudinal birth cohort study of children with and without IUCE, we conducted and analyzed data based on structured clinical interviews with 105 children (57% male) and their caregivers when the child was approximately 8.5 years old; 47% of the children had experienced IUCE. Interviews included past and current major psychological disorders and sub-threshold mental health symptoms. Potential covariates were ascertained by interviews of birth mothers and other caregivers from shortly after the child's birth until the 8.5-year visit. More than one-third of children met DSM-IV criteria for one or more mood, anxiety, attention deficit, or disruptive behavior disorders. IUCE was not significantly associated with children's history of psychological distress, in either bivariate or multiple logistic regressions. In contrast, birth mothers' acknowledgement of greater psychiatric distress at baseline and higher levels of alcohol consumption during pregnancy, and at 8.5 years caregivers' reports of their own psychological distress, and children's lower IQ were predictors of higher rates of psychological morbidity. Findings are consistent with prior reports suggesting that, regardless of IUCE status, children from low-income, urban backgrounds are at heightened risk for psychological distress. Results underscore the need for closer monitoring of the mental health of children living in low-income households, with or without intrauterine substance exposures, to facilitate access to appropriate services.
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Affiliation(s)
- Mark A Richardson
- Division of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
- Department of Psychological and Brain Sciences, Boston University, 648 Beacon Street, 2nd floor, Boston, MA, 02215, USA.
| | | | - Marjorie Beeghly
- Department of Psychology, Wayne State University, Detroit, MI, USA
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Ruth Rose-Jacobs
- Division of Developmental and Behavioral Medicine, Boston Medical Center, Boston, MA, USA
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Clara A Chen
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Danielle P Appugliese
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jane M Liebschutz
- General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Deborah A Frank
- Division of Developmental and Behavioral Medicine, Boston Medical Center, Boston, MA, USA
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
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Bona K, London WB, Guo D, Frank DA, Wolfe J. Trajectory of Material Hardship and Income Poverty in Families of Children Undergoing Chemotherapy: A Prospective Cohort Study. Pediatr Blood Cancer 2016; 63:105-11. [PMID: 26398865 DOI: 10.1002/pbc.25762] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/20/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Poverty is correlated with negative health outcomes in pediatric primary care, and is emerging as a negative prognostic indicator in pediatric oncology. However, measures of poverty amenable to targeted intervention, such as household material hardship (HMH)--including food, energy, and housing insecurity--have not been described in pediatric oncology. We describe the trajectory of family reported HMH and income poverty at a pediatric oncology referral center in New England with high psychosocial supports. PROCEDURE Single site, prospective cohort study including 99 English-speaking families of children receiving chemotherapy for primary cancer. Families completed face-to-face surveys at two time-points: (1) Within 30 days of child's diagnosis (T1) (N = 99, response rate 88%); (2) 6-months following diagnosis (T2) (N = 93, response rate 94%). HMH was assessed in three domains: food, energy, and housing insecurity. RESULTS Twenty percent of families reported low-income (≤200% Federal Poverty Level) and at least one HMH prior to their child's diagnosis. At T2, 25% of families lost >40% annual household income secondary to treatment-related work disruptions, and 29% of families reported HMH despite utilization of psychosocial supports. CONCLUSIONS Low-income and HMH are prevalent in a significant proportion of newly diagnosed pediatric oncology families at a large referral center. Despite psychosocial supports, the proportion of families experiencing unmet basic needs increases during chemotherapy to nearly one in three families. HMH provides a quantifiable and remediable measure of poverty in pediatric oncology. Interventions to ameliorate this concrete component of poverty could benefit a significant proportion of pediatric oncology families.
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Affiliation(s)
- Kira Bona
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Center for Outcomes and Population Research, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Wendy B London
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Dongjing Guo
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Deborah A Frank
- Boston University School of Medicine, Boston, Massachusetts.,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Joanne Wolfe
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Center for Outcomes and Population Research, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
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Liebschutz J, Crooks D, Rose-Jacobs R, Cabral HJ, Heeren TC, Gerteis J, Appugliese DP, Heymann OD, Lange AV, Frank DA. Prenatal substance exposure: What predicts behavioral resilience by early adolescence? Psychol Addict Behav 2015; 29:329-37. [PMID: 26076097 PMCID: PMC4593628 DOI: 10.1037/adb0000082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Understanding behavioral resilience among at-risk adolescents may guide public policy decisions and future programs. We examined factors predicting behavioral resilience following intrauterine substance exposure in a prospective longitudinal birth-cohort study of 136 early adolescents (ages 12.4-15.9 years) at risk for poor behavioral outcomes. We defined behavioral resilience as a composite measure of lack of early substance use initiation (before age 14), lack of risky sexual behavior, or lack of delinquency. Intrauterine substance exposures included in this analysis were cocaine, tobacco, alcohol, and marijuana. We recruited participants from Boston Medical Center as mother-infant dyads between 1990 and 1993. The majority of the sample was African American/Caribbean (88%) and 49% female. In bivariate analyses, none and lower intrauterine cocaine exposure level predicted resilience compared with higher cocaine exposure, but this effect was not found in an adjusted model. Instead, strict caregiver supervision (adjusted odds ratio [AOR] = 6.02, 95% confidence interval (CI) [1.90, 19.00], p = .002), lower violence exposure (AOR = 4.07, 95% CI [1.77, 9.38], p < .001), and absence of intrauterine tobacco exposure (AOR = 3.71, 95% CI [1.28, 10.74], p = .02) predicted behavioral resilience. In conclusion, caregiver supervision in early adolescence, lower violence exposure in childhood, and lack of intrauterine tobacco exposure predicted behavioral resilience among a cohort of early adolescents with significant social and environmental risk. Future interventions should work to enhance parental supervision as a way to mitigate the effects of adversity on high-risk groups of adolescents. (PsycINFO Database Record
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Affiliation(s)
- Jane Liebschutz
- Clinical Addiction Research and Education Unit, 801 Massachusetts Avenue, Boston Medical Center, Boston, MA, 02118
| | - Denise Crooks
- Department of Family Medicine, Boston Medical Center, 840 Harrison Avenue, Boston, MA, 02118
| | - Ruth Rose-Jacobs
- Department of Pediatrics, Boston University School of Medicine, Boston, 72 East Concord Street, MA, 02118
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118
| | - Timothy C Heeren
- Data Coordinating Center, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118
| | - Jessie Gerteis
- Abt Associates, Inc., 55 Wheeler Street, Cambridge, MA, 02138
| | - Danielle P. Appugliese
- Data Coordinating Center, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118
| | - Orlaith D. Heymann
- Clinical Addiction Research and Education Unit, 801 Massachusetts Avenue, Boston Medical Center, Boston, MA, 02118
| | - Allison V. Lange
- Clinical Addiction Research and Education Unit, 801 Massachusetts Avenue, Boston Medical Center, Boston, MA, 02118
| | - Deborah A. Frank
- Department of Family Medicine, Boston Medical Center, 840 Harrison Avenue, Boston, MA, 02118
- Department of Pediatrics, Boston University School of Medicine, Boston, 72 East Concord Street, MA, 02118
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Cutts DB, Coleman S, Black MM, Chilton MM, Cook JT, de Cuba SE, Heeren TC, Meyers A, Sandel M, Casey PH, Frank DA. Homelessness During Pregnancy: A Unique, Time-Dependent Risk Factor of Birth Outcomes. Matern Child Health J 2014; 19:1276-83. [DOI: 10.1007/s10995-014-1633-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Frank DA, Kuranz S, Appugliese D, Cabral H, Chen C, Crooks D, Heeren T, Liebschutz J, Richardson M, Rose-Jacobs R. Problematic substance use in urban adolescents: role of intrauterine exposures to cocaine and marijuana and post-natal environment. Drug Alcohol Depend 2014; 142:181-90. [PMID: 24999059 PMCID: PMC4180288 DOI: 10.1016/j.drugalcdep.2014.06.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 05/16/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Linkages between intrauterine exposures to cocaine and marijuana and adolescents' problematic substance use have not been fully delineated. METHODS Prospective longitudinal study with assessors unaware of intrauterine exposure history followed 157 urban participants from birth until late adolescence. Level of intrauterine exposures was identified by mother's report and infant's meconium. Problematic substance use, identified by the Voice Diagnostic Interview Schedule for Children (V-DISC) or the Audio Computer Assisted Self-Interview (ACASI) and urine assay, was a composite encompassing DSM-IV indication of tolerance, abuse, and dependence on alcohol, marijuana, and tobacco and any use of cocaine, glue, or opiates. RESULTS Twenty percent (32/157) of the sample experienced problematic substance use by age 18 years, of whom the majority (22/157) acknowledged abuse, tolerance or dependence on marijuana with or without other substances. Structural equation models examining direct and indirect pathways linking a Cox survival model for early substance initiation to a logistic regression models found effects of post-natal factors including childhood exposure to violence and household substance use, early youth substance initiation, and ongoing youth violence exposure contributing to adolescent problematic substance use. CONCLUSION We did not identify direct relationships between intrauterine cocaine or marijuana exposure and problematic substance use, but did find potentially modifiable post-natal risk factors also noted to be associated with problematic substance use in the general population including earlier substance initiation, exposure to violence and to household substance use.
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Affiliation(s)
- Deborah A. Frank
- Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, 771 Albany Street, Dowling Ground, Boston, MA 02118, United States
| | - Seth Kuranz
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, United States
| | - Danielle Appugliese
- Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, United States
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd floor, Boston, MA 02118, United States
| | - Clara Chen
- Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, United States
| | - Denise Crooks
- Department of Pediatrics, Boston Medical Center, 771 Albany Street, Dowling Ground, Boston, MA 02118, United States
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd floor, Boston, MA 02118, United States
| | - Jane Liebschutz
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 3rd floor, Boston, MA 02118, United States
| | - Mark Richardson
- Department of Psychiatry, Boston University School of Medicine, 771 Albany Street, Dowling 7 Boston, Massachusetts 02118, United States
| | - Ruth Rose-Jacobs
- Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, 771 Albany Street, Dowling Ground, Boston, MA 02118, United States
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Beeghly M, Rose-Jacobs R, Martin BM, Cabral HJ, Heeren TC, Frank DA. Level of intrauterine cocaine exposure and neuropsychological test scores in preadolescence: subtle effects on auditory attention and narrative memory. Neurotoxicol Teratol 2014; 45:1-17. [PMID: 24978115 DOI: 10.1016/j.ntt.2014.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 06/13/2014] [Accepted: 06/18/2014] [Indexed: 12/12/2022]
Abstract
Neuropsychological processes such as attention and memory contribute to children's higher-level cognitive and language functioning and predict academic achievement. The goal of this analysis was to evaluate whether level of intrauterine cocaine exposure (IUCE) alters multiple aspects of preadolescents' neuropsychological functioning assessed using a single age-referenced instrument, the NEPSY: A Developmental Neuropsychological Assessment (NEPSY) (Korkman et al., 1998), after controlling for relevant covariates. Participants included 137 term 9.5-year-old children from low-income urban backgrounds (51% male, 90% African American/Caribbean) from an ongoing prospective longitudinal study. Level of IUCE was assessed in the newborn period using infant meconium and maternal report. 52% of the children had IUCE (65% with lighter IUCE, and 35% with heavier IUCE), and 48% were unexposed. Infants with Fetal Alcohol Syndrome, HIV seropositivity, or intrauterine exposure to illicit substances other than cocaine and marijuana were excluded. At the 9.5-year follow-up visit, trained examiners masked to IUCE and background variables evaluated children's neuropsychological functioning using the NEPSY. The association between level of IUCE and NEPSY outcomes was evaluated in a series of linear regressions controlling for intrauterine exposure to other substances and relevant child, caregiver, and demographic variables. Results indicated that level of IUCE was associated with lower scores on the Auditory Attention and Narrative Memory tasks, both of which require auditory information processing and sustained attention for successful performance. However, results did not follow the expected ordinal, dose-dependent pattern. Children's neuropsychological test scores were also altered by a variety of other biological and psychosocial factors.
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Affiliation(s)
- Marjorie Beeghly
- Department of Psychology, Wayne State University, Detroit, MI, USA; Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Ruth Rose-Jacobs
- Department of Pediatrics, Boston University School of Medicine & Boston Medical Center, Boston, MA, USA.
| | - Brett M Martin
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
| | - Deborah A Frank
- Department of Pediatrics, Boston University School of Medicine & Boston Medical Center, Boston, MA, USA.
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Affiliation(s)
- Deborah A Frank
- Department of Pediatrics, Division of Growth and Development, Boston Medical Center, Boston, MA 02118, USA.
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Meyers A, Joyce K, Coleman SM, Cook JT, Cutts D, Ettinger de Cuba S, Heeren TC, Rose-Jacobs R, Black MM, Casey PH, Chilton M, Sandel M, Frank DA. Health of children classified as underweight by CDC reference but normal by WHO standard. Pediatrics 2013; 131:e1780-7. [PMID: 23690515 DOI: 10.1542/peds.2012-2382] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To ascertain measures of health status among 6- to 24-month-old children classified as below normal weight-for-age (underweight) by the Centers for Disease Control and Prevention (CDC) 2000 growth reference but as normal weight-for-age by the World Health Organization (WHO) 2006 standard. METHODS Data were gathered from children and primary caregivers at emergency departments and primary care clinics in 7 US cities. Outcome measures included caregiver rating of child health, parental evaluation of developmental status, history of hospitalizations, and admission to hospital at the time of visit. Children were classified as (1) not underweight by either CDC 2000 or WHO 2006 criteria, (2) underweight by CDC 2000 but not by WHO 2006 criteria, or (3) underweight by both criteria. Associations between these categories and health outcome measures were assessed by using multiple logistic regression analysis. RESULTS Data were available for 18 420 children. For each health outcome measure, children classified as underweight by CDC 2000 but normal by WHO 2006 had higher adjusted odds ratios (aORs) of adverse health outcomes than children not classified as underweight by either; children classified as underweight by both had the highest aORs of adverse outcomes. For example, compared with children not underweight by either criteria, the aORs for fair/poor health rating were 2.54 (95% confidence interval: 2.20-2.93) among children underweight by CDC but not WHO and 3.76 (3.13-4.51) among children underweight by both. CONCLUSIONS Children who are reclassified from underweight to normal weight in changing from CDC 2000 to WHO 2006 growth charts may still be affected by morbidities associated with underweight.
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Affiliation(s)
- Alan Meyers
- Department of Pediatrics, Boston Medical Center, Boston, MA 02118, USA.
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Cook JT, Frank DA, Coleman S, Cuba SE, Pasquariello J. Very low food security in young citizen children correlates with mothers’ foreign birth; associations vary by mothers’ length of stay in the US. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.369.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Sharon Coleman
- Data Coordinating Center, BU Sch of Public HealthBostonMA
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Cook JT, Black M, Chilton M, Cutts D, Ettinger de Cuba S, Heeren TC, Rose-Jacobs R, Sandel M, Casey PH, Coleman S, Weiss I, Frank DA. Are Food Insecurity's Health Impacts Underestimated in the U.S. Population? Marginal Food Security Also Predicts Adverse Health Outcomes in Young U.S. Children and Mothers. Adv Nutr 2013. [DOI: 10.3945/an.112.003228 [doi]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cook JT, Black M, Chilton M, Cutts D, Ettinger de Cuba S, Heeren TC, Rose-Jacobs R, Sandel M, Casey PH, Coleman S, Weiss I, Frank DA. Are food insecurity's health impacts underestimated in the U.S. population? Marginal food security also predicts adverse health outcomes in young U.S. children and mothers. Adv Nutr 2013; 4:51-61. [PMID: 23319123 PMCID: PMC3648739 DOI: 10.3945/an.112.003228] [Citation(s) in RCA: 198] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This review addresses epidemiological, public health, and social policy implications of categorizing young children and their adult female caregivers in the United States as food secure when they live in households with "marginal food security," as indicated by the U.S. Household Food Security Survey Module. Existing literature shows that households in the US with marginal food security are more like food-insecure households than food-secure households. Similarities include socio-demographic characteristics, psychosocial profiles, and patterns of disease and health risk. Building on existing knowledge, we present new research on associations of marginal food security with health and developmental risks in young children (<48 mo) and health in their female caregivers. Marginal food security is positively associated with adverse health outcomes compared with food security, but the strength of the associations is weaker than that for food insecurity as usually defined in the US. Nonoverlapping CIs, when comparing odds of marginally food-secure children's fair/poor health and developmental risk and caregivers' depressive symptoms and fair/poor health with those in food-secure and -insecure families, indicate associations of marginal food security significantly and distinctly intermediate between those of food security and food insecurity. Evidence from reviewed research and the new research presented indicates that households with marginal food security should not be classified as food secure, as is the current practice, but should be reported in a separate discrete category. These findings highlight the potential underestimation of the prevalence of adverse health outcomes associated with exposure to lack of enough food for an active, healthy life in the US and indicate an even greater need for preventive action and policies to limit and reduce exposure among children and mothers.
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Affiliation(s)
- John T Cook
- Department of Pediatrics, Boston University School of Medicine, MA, USA.
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Black MM, Quigg AM, Cook J, Casey PH, Cutts DB, Chilton M, Meyers A, Ettinger de Cuba S, Heeren T, Coleman S, Rose-Jacobs R, Frank DA. WIC participation and attenuation of stress-related child health risks of household food insecurity and caregiver depressive symptoms. ACTA ACUST UNITED AC 2012; 166:444-51. [PMID: 22566545 DOI: 10.1001/archpediatrics.2012.1] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To examine how family stressors (household food insecurity and/or caregiver depressive symptoms) relate to child health and whether participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) attenuates stress-related child health risks. DESIGN Cross-sectional family stress and cumulative stress models from January 1, 2000, through December 31, 2010. SETTING Families recruited from emergency departments and/or primary care in Baltimore, Boston, Little Rock, Los Angeles, Minneapolis, Philadelphia, and Washington, DC. PARTICIPANTS Participants included 26,950 WIC-eligible caregivers and children younger than 36 months; 55.2% were black, 29.9% were Hispanic, and 13.0% were white. Caregivers' mean age was 25.6 years; 68.6% were US-born, 64.7% had completed high school, 38.0% were married, and 36.5% were employed. MAIN EXPOSURES Of the participants, 24.0% had household food insecurity and 24.4% had depressive symptoms; 9.1% had both stressors, 29.9% had 1 stressor, and 61.0% had neither; 89.7% were WIC participants. OUTCOME MEASURES Caregivers reported child health, lifetime hospitalizations, and developmental risk. Weight and length were measured. We calculated weight-for-age and length-for-age z scores and the risk of underweight or overweight. The well-child composite comprised good/excellent health, no hospitalizations, no developmental risk, and neither underweight nor overweight. RESULTS In multivariate analyses adjusted for covariates, as stressors increased, odds of fair/poor health, hospitalizations, and developmental risk increased and odds of well-child status decreased. Interactions between WIC participation and stressors favored WIC participants over nonparticipants in dual stressor families on 3 child health indicators: (1) fair/poor health: WIC participants, adjusted odds ratio (aOR), 1.89 (95% CI, 1.66-2.14) vs nonparticipants, 2.35 (2.16-4.02); (2) well-child status: WIC participants, 0.73 (0.62-0.84) vs nonparticipants, 0.34 (0.21-0.54); and (3) overweight: WIC participants, 1.01 (0.88-1.16) vs nonparticipants, 1.48 (1.04-2.11) (P = .06). CONCLUSIONS As stressors increased, child health risks increased. WIC participation attenuates but does not eliminate child health risks.
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Affiliation(s)
- Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Bar-Natan M, Nelson EA, Walker SR, Kuang Y, Distel RJ, Frank DA. Dual inhibition of Jak2 and STAT5 enhances killing of myeloproliferative neoplasia cells. Leukemia 2011; 26:1407-10. [DOI: 10.1038/leu.2011.338] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cutts DB, Meyers AF, Black MM, Casey PH, Chilton M, Cook JT, Geppert J, Ettinger de Cuba S, Heeren T, Coleman S, Rose-Jacobs R, Frank DA. US Housing insecurity and the health of very young children. Am J Public Health 2011; 101:1508-14. [PMID: 21680929 PMCID: PMC3134514 DOI: 10.2105/ajph.2011.300139] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated the association between housing insecurity and the health of very young children. METHODS Between 1998 and 2007, we interviewed 22,069 low-income caregivers with children younger than 3 years who were seen in 7 US urban medical centers. We assessed food insecurity, child health status, developmental risk, weight, and housing insecurity for each child's household. Our indicators for housing insecurity were crowding (> 2 people/bedroom or>1 family/residence) and multiple moves (≥ 2 moves within the previous year). RESULTS After adjusting for covariates, crowding was associated with household food insecurity compared with the securely housed (adjusted odds ratio [AOR] = 1.30; 95% confidence interval [CI] = 1.18, 1.43), as were multiple moves (AOR = 1.91; 95% CI = 1.59, 2.28). Crowding was also associated with child food insecurity (AOR = 1.47; 95% CI = 1.34, 1.63), and so were multiple moves (AOR = 2.56; 95% CI = 2.13, 3.08). Multiple moves were associated with fair or poor child health (AOR = 1.48; 95% CI =1.25, 1.76), developmental risk (AOR 1.71; 95% CI = 1.33, 2.21), and lower weight-for-age z scores (-0.082 vs -0.013; P= .02). CONCLUSIONS Housing insecurity is associated with poor health, lower weight, and developmental risk among young children. Policies that decrease housing insecurity can promote the health of young children and should be a priority.
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Affiliation(s)
- Diana Becker Cutts
- Department of Pediatrics, Diana Becker Cutts, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
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Rose-Jacobs R, Soenksen S, Appugliese DP, Cabral HJ, Richardson MA, Beeghly M, Heeren TC, Frank DA. Early adolescent executive functioning, intrauterine exposures and own drug use. Neurotoxicol Teratol 2011; 33:379-92. [PMID: 21371553 PMCID: PMC3145371 DOI: 10.1016/j.ntt.2011.02.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 02/22/2011] [Accepted: 02/24/2011] [Indexed: 12/21/2022]
Abstract
Individual differences in adolescents' executive functioning are often attributed either to intrauterine substance exposure or to adolescents' own substance use, but both predictors typically have not been evaluated simultaneously in the same study. This prospective study evaluated whether intrauterine drug exposures, the adolescents' own substance use, and/or their potential interactions are related to poorer executive functioning after controlling for important contextual variables. Analyses were based on data collected on a sample of 137 predominantly African-American/African Caribbean adolescents from low-income urban backgrounds who were followed since their term birth. Intrauterine substance exposures (cocaine, marijuana, alcohol, and cigarettes) and adolescents' substance use were documented using a combination of biological assays and maternal and adolescent self-report. At 12-14 years of age, examiners masked to intrauterine exposures and current substance use assessed the adolescents using the Delis-Kaplan Executive Function System (D-KEFS), an age-referenced instrument evaluating multiple dimensions of executive functioning (EF). Results of covariate-controlled analyses in this study suggest that when intrauterine substance exposures and young adolescents' substance use variables were in the same analysis models, subtle differences in specific EF outcomes were identifiable in this non-referred sample. While further study with larger samples is indicated, these findings suggest that 1) research on adolescent substance use and intrauterine exposure research should evaluate both predictors simultaneously, 2) subtle neurocognitive effects associated with specific intrauterine drug exposures can be identified during early adolescence, and 3) intrauterine substance exposure effects may differ from those associated with adolescents' own drug use.
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Affiliation(s)
- Ruth Rose-Jacobs
- Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, 88 East Newton Street, Boston, MA 02118, United States.
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Frank DA, Rose-Jacobs R, Crooks D, Cabral HJ, Gerteis J, Hacker KA, Martin B, Weinstein ZB, Heeren T. Adolescent initiation of licit and illicit substance use: Impact of intrauterine exposures and post-natal exposure to violence. Neurotoxicol Teratol 2011; 33:100-9. [PMID: 20600847 PMCID: PMC3000885 DOI: 10.1016/j.ntt.2010.06.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 03/09/2010] [Accepted: 06/08/2010] [Indexed: 11/29/2022]
Abstract
Whether intrauterine exposures to alcohol, tobacco, marijuana, or cocaine predispose offspring to substance use in adolescence has not been established. We followed a sample of 149 primarily African American/African Caribbean, urban adolescents, recruited at term birth, until age 16 to investigate intrauterine cocaine exposure (IUCE). We found that in Kaplan-Meier analyses higher levels of IUCE were associated with a greater likelihood of initiation of any substance (licit or illicit), as well as marijuana and alcohol specifically. Adolescent initiation of other illicit drugs and cigarettes were analyzed only in the "any" summary variable since they were used too infrequently to analyze as individual outcomes. In Cox proportional hazard models controlling for intrauterine exposure to alcohol, tobacco, and marijuana and demographic and post-natal covariates, those who experienced heavier IUCE had a greater likelihood of initiation of any substance, and those with lighter intrauterine marijuana exposure had a greater likelihood of initiation of any substance as well as of marijuana specifically. Time-dependent higher levels of exposure to violence between ages of 8 and 16 were also robustly associated with initiation of any licit or illicit substance, and of marijuana, and alcohol particularly.
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Affiliation(s)
- Deborah A Frank
- Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, 725 Massachusetts Avenue, Mezzanine SW, Boston, MA 02118, USA.
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Hager ER, Quigg AM, Black MM, Coleman SM, Heeren T, Rose-Jacobs R, Cook JT, Ettinger de Cuba SA, Casey PH, Chilton M, Cutts DB, Meyers AF, Frank DA. Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics 2010; 126:e26-32. [PMID: 20595453 DOI: 10.1542/peds.2009-3146] [Citation(s) in RCA: 753] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To develop a brief screen to identify families at risk for food insecurity (FI) and to evaluate the sensitivity, specificity, and convergent validity of the screen. PATIENTS AND METHODS Caregivers of children (age: birth through 3 years) from 7 urban medical centers completed the US Department of Agriculture 18-item Household Food Security Survey (HFSS), reports of child health, hospitalizations in their lifetime, and developmental risk. Children were weighed and measured. An FI screen was developed on the basis of affirmative HFSS responses among food-insecure families. Sensitivity and specificity were evaluated. Convergent validity (the correspondence between the FI screen and theoretically related variables) was assessed with logistic regression, adjusted for covariates including study site; the caregivers' race/ethnicity, US-born versus immigrant status, marital status, education, and employment; history of breastfeeding; child's gender; and the child's low birth weight status. RESULTS The sample included 30,098 families, 23% of which were food insecure. HFSS questions 1 and 2 were most frequently endorsed among food-insecure families (92.5% and 81.9%, respectively). An affirmative response to either question 1 or 2 had a sensitivity of 97% and specificity of 83% and was associated with increased risk of reported poor/fair child health (adjusted odds ratio [aOR]: 1.56; P < .001), hospitalizations in their lifetime (aOR: 1.17; P < .001), and developmental risk (aOR: 1.60; P < .001). CONCLUSIONS A 2-item FI screen was sensitive, specific, and valid among low-income families with young children. The FI screen rapidly identifies households at risk for FI, enabling providers to target services that ameliorate the health and developmental consequences associated with FI.
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Affiliation(s)
- Erin R Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Frank DA, Chilton M, Casey PH, Black MM, Cook JT, Cutts DB, Meyers AF. Nutritional-assistance programs play a critical role in reducing food insecurity. Pediatrics 2010; 125:e1267; author reply e1267-8. [PMID: 20435705 DOI: 10.1542/peds.2010-0808] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Deborah A. Frank
- Department of Pediatrics, Boston University School of Medicine, Boston, MA 02118, Grow Team for Children, Boston Medical Center, Boston, MA 02118
| | - Mariana Chilton
- Department of Health Management and Policy, Drexel University School of Public Health, Philadelphia, PA 19102-1192
| | - Patrick H. Casey
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | - Maureen M. Black
- Growth and Nutrition Division, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201-1559
| | - John T. Cook
- Department of Pediatrics,Boston University School of Medicine and Boston Medical Center,Boston, MA 02118
| | - Diana Becker Cutts
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, MN 55415
| | - Alan F. Meyers
- Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118
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Frank DA, Casey PH, Black MM, Rose-Jacobs R, Chilton M, Cutts D, March E, Heeren T, Coleman S, Ettinger de Cuba S, Cook JT. Cumulative hardship and wellness of low-income, young children: multisite surveillance study. Pediatrics 2010; 125:e1115-23. [PMID: 20385641 DOI: 10.1542/peds.2009-1078] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The goals were to generate a cumulative hardship index and to evaluate its association with the well-being of children 4 to 36 months of age without private health insurance. METHODS Cross-sectional surveys were linked to anthropometric measures and medical record review at 5 urban medical centers (July 1, 2004, to December 31, 2007). Cumulative hardship index scores ranged from 0 to 6, with food, housing, and energy each contributing a possible score of 0 (secure), 1 (moderately insecure), or 2 (severely insecure) to generate scores indicating no hardship (score of 0), moderate hardship (scores of 1-3), or severe hardship (scores of 4-6). The outcome was a composite indicator of child wellness, including caregivers' reports of children's good/excellent heath, no hospitalizations, not being developmentally at risk, and anthropometric measurements within normal limits. Covariates were selected a priori and through association with predictors and outcomes. RESULTS Of 7141 participants, 37% reported no material hardship, 57% moderate hardship, and 6% severe hardship. Multivariate logistic regression analyses showed ordinal association between the cumulative hardship index and children's adjusted odds of wellness (severe versus no hardship, adjusted odds ratio [AOR]: 0.65 [95% confidence interval [CI]: 0.51-0.83]; severe versus moderate hardship, AOR: 0.73 [95% CI: 0.58-0.92]; moderate versus no hardship, AOR: 0.89 [95% CI: 0.79-0.99]). CONCLUSION Increasing levels of a composite measure of remediable adverse material conditions correlated with decreasing adjusted odds of wellness among young US children.
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Affiliation(s)
- Deborah A Frank
- Boston Medical Center, Department of Pediatrics, Boston, MA 02118, USA.
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Rose-Jacobs R, Waber D, Beeghly M, Cabral H, Appugleise D, Heeren T, Marani J, Frank DA. Intrauterine cocaine exposure and executive functioning in middle childhood. Neurotoxicol Teratol 2009; 31:159-68. [PMID: 19146950 PMCID: PMC2774774 DOI: 10.1016/j.ntt.2008.12.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 12/11/2008] [Accepted: 12/11/2008] [Indexed: 11/21/2022]
Abstract
This longitudinal study evaluated whether the level of intrauterine cocaine exposure (IUCE) or the interaction between IUCE and contextual variables was related during middle childhood to executive functioning, as assessed with the Stroop Color-Word and Rey Osterrieth Complex Figure tests. The Stroop Interference score measures verbal inhibitory control while the Rey Osterrieth Organizational score evaluates skills such as planning, organization and perception. Masked examiners assessed 143 children at 9.5 and 11 years of age (74 with IUCE and 69 demographically similar children without IUCE). Level of IUCE (Unexposed; Lighter, and Heavier) was documented by positive postpartum maternal reports and infant meconium assays. In covariate-controlled regressions, level of IUCE was not significantly associated with Stroop Interference or Rey Osterrieth Organization scores. However, in covariate controlled post-hoc tests comparing the Heavier exposed group to the combined Lighter/Unexposed group, children in the Heavier group had significantly poorer Stroop Interference scores, but there was no significant group difference for Rey Osterrieth Organizational scores. Children's average Organization scores in Unexposed, Lighter, and Heavier exposed groups were well below the test norm means. Results of this study indicate that heavier IUCE may be associated with mild compromise on school-aged children's ability to inhibit prepotent verbal responses.
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Affiliation(s)
- Ruth Rose-Jacobs
- Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA 02118, USA.
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Chilton M, Black MM, Berkowitz C, Casey PH, Cook J, Cutts D, Jacobs RR, Heeren T, de Cuba SE, Coleman S, Meyers A, Frank DA. Food insecurity and risk of poor health among US-born children of immigrants. Am J Public Health 2008; 99:556-62. [PMID: 19106417 DOI: 10.2105/ajph.2008.144394] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated the risk of household food insecurity and reported fair or poor health among very young children who were US citizens and whose mothers were immigrants compared with those whose mothers had been born in the United States. METHODS Data were obtained from 19,275 mothers (7216 of whom were immigrants) who were interviewed in hospital-based settings between 1998 and 2005 as part of the Children's Sentinel Nutrition Assessment Program. We examined whether food insecurity mediated the association between immigrant status and child health in relation to length of stay in the United States. RESULTS The risk of fair or poor health was higher among children of recent immigrants than among children of US-born mothers (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.02, 1.55; P < .03). Immigrant households were at higher risk of food insecurity than were households with US-born mothers. Newly arrived immigrants were at the highest risk of food insecurity (OR = 2.45; 95% CI = 2.16, 2.77; P < .001). Overall, household food insecurity increased the risk of fair or poor child health (OR = 1.74; 95% CI = 1.57, 1.93; P < .001) and mediated the association between immigrant status and poor child health. CONCLUSIONS Children of immigrant mothers are at increased risk of fair or poor health and household food insecurity. Policy interventions addressing food insecurity in immigrant households may promote child health.
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Affiliation(s)
- Mariana Chilton
- Drexel University, School of Public Health, 1505 Race St, Philadelphia, PA 19102-1192, USA.
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Chartrand MM, Frank DA, White LF, Shope TR. Effect of Parents' Wartime Deployment on the Behavior of Young Children in Military Families. ACTA ACUST UNITED AC 2008; 162:1009-14. [DOI: 10.1001/archpedi.162.11.1009] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Cook JT, Frank DA, Casey PH, Rose-Jacobs R, Black MM, Chilton M, Ettinger de Cuba S, Appugliese D, Coleman S, Heeren T, Berkowitz C, Cutts DB. A brief indicator of household energy security: associations with food security, child health, and child development in US infants and toddlers. Pediatrics 2008; 122:e867-75. [PMID: 18829785 DOI: 10.1542/peds.2008-0286] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Household energy security has not been measured empirically or related to child health and development but is an emerging concern for clinicians and researchers as energy costs increase. The objectives of this study were to develop a clinical indicator of household energy security and assess associations with food security, health, and developmental risk in children <36 months of age. METHODS A cross-sectional study that used household survey and surveillance data was conducted. Caregivers were interviewed in emergency departments and primary care clinics form January 2001 through December 2006 on demographics, public assistance, food security, experience with heating/cooling and utilities, Parents Evaluation of Developmental Status, and child health. The household energy security indicator includes energy-secure, no energy problems; moderate energy insecurity, utility shutoff threatened in past year; and severe energy insecurity, heated with cooking stove, utility shutoff, or >or=1 day without heat/cooling in past year. The main outcome measures were household and child food security, child reported health status, Parents Evaluation of Developmental Status concerns, and hospitalizations. RESULTS Of 9721 children, 11% (n = 1043) and 23% (n = 2293) experienced moderate and severe energy insecurity, respectively. Versus children with energy security, children with moderate energy insecurity had greater odds of household food insecurity, child food insecurity, hospitalization since birth, and caregiver report of child fair/poor health, adjusted for research site and mother, child, and household characteristics. Children with severe energy insecurity had greater adjusted odds of household food insecurity, child food insecurity, caregivers reporting significant developmental concerns on the Parents Evaluation of Developmental Status scale, and report of child fair/poor health. No significant association was found between energy security and child weight for age or weight for length. CONCLUSIONS As household energy insecurity increases, infants and toddlers experienced increased odds of household and child food insecurity and of reported poor health, hospitalizations, and developmental risks.
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Affiliation(s)
- John T Cook
- Department of Pediatrics, Boston Medical Center, Boston, MA 02118, USA.
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