Association between maternal prenatal depressive symptoms and offspring epigenetic aging at 3-5 weeks

Epigenetic clocks are emerging as tools for assessing acceleration and deceleration of biological age during childhood. Maternal depression during pregnancy may affect the biological aging of offspring and related development. In a low-income cohort of mother-child dyads, we investigated the relationship between prenatal maternal depressive symptoms and infant epigenetic age residuals, which represent the deviation (acceleration or deceleration) that exists between predicted biological age and chronological age. The epigenetic age residuals were derived from a pediatric-specific buccal epithelial clock. We hypothesized that maternal depressive symptoms, both sub-clinical and elevated (clinical level), would be associated with estimated biological age deceleration in offspring during early infancy. We analyzed data from 94 mother-child dyads using the Edinburgh Postnatal Depression Scale (EPDS) and DNA methylation derived from offspring buccal cells collected at 3-5 weeks of age. There was a significant non-linear association between the EPDS score and epigenetic age residual (β = -0.017, 95% confidence interval: -0.03,-0.01, P = <0.01). The results indicated that infants of mothers with sub-clinical depressive symptoms had the lowest infant epigenetic age residuals while infants of mothers with no-to-low depressive symptoms had the highest and experienced biological age acceleration. Maternal depressive symptoms may influence the biological aging of offspring living in poverty.

Neighborhood Predictors of Poor Prenatal Care and Well-Child Visit Attendance

PURPOSE

Women and children continue to miss preventive visits. Which neighborhood factors predict inadequate prenatal care (PNC) and well-child visit (WCV) attendance remain unclear.

DESCRIPTION

In a retrospective case-control study at Virginia Commonwealth University Health System, mothers with less than 50% adherence or initiation after 5 months gestation were eligible as cases and those with ≥ 80% adherence and initiation before 5 months were eligible as controls. Children in the lowest quintile of adherence were eligible as cases and those with ≥ 80% of adherence were eligible as controls. Cases and controls were randomly selected at a 1:2 ratio and matched on birth month. Covariates were derived from the 2018 American Community Survey. A hotspot was defined as a zip code tabulation area (ZCTA) with a proportion of controls less than 0.66. ZCTAs with fewer than 5 individuals were excluded. Weighted quantile regression was used to determine which covariates were most associated with inadequate attendance.

ASSESSMENT

We identified 38 and 35 ZCTAs for the PNC and WCV analyses, respectively. Five of 11 hotspots for WCV were also hotspots for PNC. Education and income predicted 51% and 34% of the variation in missed PNCs, respectively; language, education and transportation difficulties explained 33%, 29%, and 17% of the variation in missed WCVs, respectively. Higher proportions of Black residents lived in hotspots of inadequate PCV and WCV attendance.

CONCLUSION

Neighborhood-level factors performed well in predicting inadequate PCV and WCV attendance. The disproportionate impact impact of inadequate PCV and WCV in neighborhoods where higher proportions of Black people lived highlights the potential influence of systemic racism and segregation on healthcare utilization.

The promise and pitfalls of a strength-based approach to child poverty and neurocognitive development: Implications for policy

There has been significant progress in understanding the effects of childhood poverty on neurocognitive development. This progress has captured the attention of policymakers and promoted progressive policy reform. However, the prevailing emphasis on the harms associated with childhood poverty may have inadvertently perpetuated a deficit-based narrative, focused on the presumed shortcomings of children and families in poverty. This focus can have unintended consequences for policy (e.g., overlooking strengths) as well as public discourse (e.g., focusing on individual rather than systemic factors). Here, we join scientists across disciplines in arguing for a more well-rounded, "strength-based" approach, which incorporates the positive and/or adaptive developmental responses to experiences of social disadvantage. Specifically, we first show the value of this approach in understanding normative brain development across diverse human environments. We then highlight its application to educational and social policy, explore pitfalls and ethical considerations, and offer practical solutions to conducting strength-based research responsibly. Our paper re-ignites old and recent calls for a strength-based paradigm shift, with a focus on its application to developmental cognitive neuroscience. We also offer a unique perspective from a new generation of early-career researchers engaged in this work, several of whom themselves have grown up in conditions of poverty. Ultimately, we argue that a balanced strength-based scientific approach will be essential to building more effective policies.

Differences in the temporal trends of childhood overweight and obesity in Spain in the 2011-2019 period by sex, age and socioeconomic level: results of the ALADINO study

INTRODUCTION

Childhood excess weight is a growing public health problem. The aim of this study was to assess temporal trends in the prevalence of overweight, obesity and central obesity in schoolchildren aged 6-9 years in Spain between 2011 and 2019 based on demographic and socioeconomic characteristics.

METHODOLOGY

The analysis included data from the 2011, 2015 and 2019 rounds of the cross-sectional observational and descriptive ALADINO study in schoolchildren of both sexes aged 6-9 years. We conducted a descriptive analysis of the trends in the prevalence of overweight and obesity (defined according to the criteria of the World Health Organization and the International Obesity Task Force) and of central obesity, in addition to associated demographic and socioeconomic variables.

RESULTS

Between 2011 and 2019, the prevalence of overweight (WHO criteria) decreased in boys aged 6, 7 and 8 years (by -5.4%, -5.7% and -5.3%, respectively) and boys whose parents had a higher educational attainment (by -5.3%). In relation to the socioeconomic level, overweight in boys declined at all income levels. However, between 2011 and 2019, both the prevalence of overweight in girls and the prevalence of obesity (applying the WHO and IOTF criteria) and the prevalence of central obesity in both sexes remained stable.

CONCLUSIONS

The prevalence of overweight and the prevalence of obesity in schoolchildren aged 6-9 years in Spain remain high. Between 2011 and 2019, the prevalence of overweight in children aged 6-8 years and in children whose parents had university degrees decreased, whereas obesity in boys, overweight and obesity in girls and central obesity in both sexes remained stable.

Health-related quality of life of children from low-income families: the new patterns study

BACKGROUND

Child poverty has been gradually rising, and about 12% of all Norwegian children are living in a state of relative poverty. This study was part of the New Patterns project, which recruits low-income families requiring long-term welfare services. Included families receive integrated welfare services, with the help of a family coordinator. The current study objectives were to explore the associations between HRQoL, demographic variables (age, gender, immigration status) and leisure activities in children and adolescents in low-income families.

METHODS

A cross-sectional survey was conducted among low-income families. Participating families had children (N = 214) aged 8-18 years.The family had a household income below 60% of the equivalized median population income for three consecutive years and needed long-term welfare services. HRQoL was measured using the KIDSCREEN-27 self-report instrument. Descriptive statistics, including means, standard deviations, and proportions, were calculated, and ordinary least squares regressions were performed, clustering standard errors at the family level.

RESULTS

Compared with boys, girls reported lower HRQoL on only one out of five dimensions, physical wellbeing. In the regression analysis we found statistically significant positive associations between migrant status and HRQoL on all five dimensions: physical wellbeing, psychological wellbeing, parents and autonomy, peers and social support, and school environment. In addition, age was associated with school environment, and age, gender and participation in leisure activities was associated with better physical wellbeing.

CONCLUSIONS

Baseline results regarding HRQoL among children and adolescents in low-income families indicate that they have overall good HRQoL, though some participants had low HRQoL scores, especially on the physical and social support dimensions. Children with an immigrant background report higher HRQoL than do children without an immigrant background.

The United States' Record-Low Child Poverty Rate in International and Historical Perspective: A Research Note

In 2021, the federal government of the United States expanded a set of income transfers that led to strong reductions in child poverty. This research note uses microdata from more than 50 countries and U.S. data spanning more than 50 years to place the 2021 child poverty rate in historical and international perspective. We demonstrate that whether using the Supplemental Poverty Measure (SPM), relative poverty measures, or an absolute poverty measure, the U.S. child poverty rate in 2021 was at its lowest level since at least 1967. The U.S. tax and transfer system reduced the 2021 SPM child poverty rate by more than 75% relative to the pre-tax/transfer child poverty rate; this reduction was three times the mean reduction effect between 1967 and 2019. These policy changes improved the country's standing from having a relative poverty rate twice that of Germany's in 2019 to the same as Germany's in 2021. Moreover, the U.S. progressed from reducing child poverty at less than half the rate of Norway in 2019 to a rate comparable to Norway in 2021. However, the U.S. success was temporary: after the expiration of the 2021 income provisions, the child poverty rate doubled and returned to being higher than in most other high-income countries.

Socioeconomic and gender inequalities in childhood obesity in Spain

INTRODUCTION

Childhood obesity is inversely associated with household socioeconomic status in high-income countries. Our aim was to explore the association between childhood weight status and household socioeconomic status in Spain in relation to family characteristics, perceptions and lifestyle habits and the school environment.

METHODS

We performed a descriptive analysis of child weight status according to family socioeconomic factors and mediating variables based on data from the ALADINO 2019 study in a sample of 16,665 schoolchildren representative of the population aged 6-9 years in Spain.

RESULTS

The prevalence of childhood obesity in households with low socioeconomic status (26.8% boys; 20.4% girls) was, in both sexes, twice as high as in those with higher socioeconomic status (12.1% boys; 8.7% girls). Unhealthy eating habits, sedentary lifestyles (mainly in girls) and the presence of screens in the bedroom (more prevalent in boys) were more frequent in school-aged children from low-income households. On the other hand, in the most disadvantaged households, a history of breastfeeding and physical activity (especially in girls) were less frequent. Similarly, schools attended by children from low-income households were less likely to have their own kitchens and indoor gymnasiums or offer sports activities.

CONCLUSION

A lower household socioeconomic status was associated with poorer dietary and physical activity habits and certain characteristics of the family and school environments that mediate the inverse association between household socioeconomic status and the prevalence of childhood obesity. Girls were less physically active and reported more sedentary lifestyles, while boys had greater access to screens. Interventions to combat childhood obesity should address the identified inequalities.

Inequalities in Wellbeing in Lebanese Children and Different Refugee Subpopulations: A Multidimensional Child Deprivation Analysis

Background and Objectives

This study constitutes the first attempt to describe the overlapping deprivations faced by Lebanese children (Lebanese) and that of the three sub-populations of refugees living in Lebanon: Palestinian refugees living in Lebanon, Palestinian refugees from Syria and Syrian refugees.

Methods

Using data from the United Nations International Children's Emergency Fund (UNICEF) Household Survey 2016 (n = 10,555 Lebanese; 7,106 Palestinian refugees living in Lebanon; 2,768 Palestinian refugees from Syria and 5,891 Syrian refugee children aged 2 to 17 years old), we report on single and overlapping deprivations (at least two concurrent deprivations) using indicators related to survival (nutrition, health, water, sanitation and overcrowding), development (education) and protection (labor, exposure to violence and early marriage). Maternal education and geographical correlates of deprivation were explored using multivariable logistic regression models clustering for children in the same households.

Main Results

In terms of co-occurrence of deprivations, Syrian refugees had the highest prevalence in all age groups (68.5%, 2-4y and 65.7%, 6-17y), followed by Palestinian refugees from Syria (46.2%, 2-4y and 45.5%, 6-17y), Palestinian refugees living in Lebanon (28.9%, 2-4y and 23.7%, 6-17y), with Lebanese children having the lowest prevalence (13.2%, 2-4y and 15.3, 6-17y). About half of Palestinian refugees from Syria and Syrian refugees (6-17y) were deprived in protection and housing. Education deprivation is of primary concern for Syrian children. Higher maternal education was consistently associated with lower odds of co-occurrence of deprivations among children aged 6-17y.

Conclusion

This study highlights the importance of including refugee populations in reporting frameworks. This analysis additionally generates geographical and socio-economic profiles of the deprived children and identifies key deprivation areas of the affected sub-groups to inform effective policy design especially in light of the prevailing economic crisis.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12187-023-10040-2.

How does the local area deprivation influence life chances for children in poverty in Wales: A record linkage cohort study

Objectives

Children growing up in poverty are less likely to achieve in school and more likely to experience mental health problems. This study examined factors in the local area that can help a child overcome the negative impact of poverty.

Design

A longitudinal record linkage retrospective cohort study.

Participants

This study included 159,131 children who lived in Wales and completed their age 16 exams (Key Stage 4 (KS4)) between 2009 and 2016. Free School Meal (FSM) provision was used as an indicator of household-level deprivation. Area-level deprivation was measured using the Welsh Index of Multiple Deprivation (WIMD) 2011. An encrypted unique Anonymous Linking Field was used to link the children with their health- and educational records.

Outcome measures

The outcome variable 'Profile to Leave Poverty' (PLP) was constructed based on successful completion of age 16 exams, no mental health condition, no substance and alcohol misuse records in routine data. Logistic regression with stepwise model selection was used to investigate the association between local area deprivation and the outcome variable.

Results

22% of children on FSM achieved PLP compared to 54.9% of non-FSM children. FSM Children from least deprived areas were significantly more likely to achieve PLP (adjusted odds ratio (aOR) - 2.20 (1.93, 2.51)) than FSM children from most deprived areas. FSM children, living in areas with higher community safety, higher relative income, higher access to services, were more likely to achieve PLP than their peers.

Conclusion

The findings indicate that community-level improvements such as increasing safety, connectivity and employment might help in child's education attainment, mental health and reduce risk taking behaviours.

I Don't Care Who You Are: Adult Respondent Selection Does Not Alter Child Deprivation Estimates

The last decade has seen strong developments in child poverty measurement. Children are largely recognised to have age-specific needs, which has led to the development of child-specific poverty measures. One of the current ongoing debates is how best to collect that information. Questions regarding child deprivation are most often answered by a reference adult and assume that adult respondents provide accurate reports about their children's needs. These assumptions have largely gone untested. Making use of a unique feature of the Fijian Household Income and Expenditure Survey (2019/20), this paper explores the effect of respondent selection on child deprivation estimates. We compare three approaches to the selection of adult respondents commonly used in survey design: the children's mother, the household head, and a random adult respondent in the household. We find that adults largely agree on whether children are deprived of specific items. However, in between 5 to 24% of households (depending on the indicator), adults provide different responses regarding whether children have specific items. Despite these differences, respondent selection does not substantially alter child multiple deprivation estimates or the socio-demographic characteristics of the deprived child population. The article will be of interest to those designing surveys or questionnaires to measure child poverty and children's unmet needs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12187-023-10025-1.

Increased Prescribing of Psychotropic Drugs or School-Based Services for Children with Disabilities? Associations of These Self-control-Boosting Strategies with Juvenile Violence at the State Level

The increasing rates at which psychotropic drugs have been prescribed to children and adolescents in the USA in the last three decades (since the early 1990s) have prompted questions about whether this trend is associated with the "great American crime decline." Medicalization can be considered one of the strategies to remedy children's neuropsychological deficits and improve their self-control. Another possible remedy is school-based services for children with learning disabilities, mandated by the Individuals with Disabilities Education Improvement Act (IDEA) of 2004. Using state-level panel data analyses for years 1990-2014 (with the main focus on 2000-2014 outcomes), the current study estimates associations between these two developmental self-control remedies-medicalization and school-based services-and minor, moderate, and severe types of juvenile violence, while controlling for relevant covariates (both time-varying and time-invariant). The results of mixed-effects linear regression analyses accounting for powerful time trends show a strong association between increases in school-based services for children with learning disabilities and declines in all types of juvenile violence. Another strong and consistent finding that emerges in the analyses is the link between reductions in child poverty at the state level and decreases in juvenile violence, both contemporaneously and over time. Psychotropic drug prescribing to children (measured using Supplemental Security Income rolls of children with mental health conditions) exhibits inconsistent or insignificant effects. The findings of this study have substantial theoretical and policy implications and indicate the importance of strengthening school-based services for children with disabilities and reducing child poverty as essential violence prevention tools.

Ameliorating Child poverty through Connecting Economic Services with child health Services (ACCESS): study protocol for a randomised controlled trial of the healthier wealthier families model in Sweden

BACKGROUND

Sweden is often held up as an example of a country with low child deprivation; yet, rates of relative deprivation are rising. Every municipality in Sweden is required to provide free, timely and accessible budget and debt counselling under the Social Services Act. The services have been encouraged to perform preventative practice with families; however, this has not been realised. The Healthier Wealthier Families (HWF) model embeds universal screening for economic hardship into child health services and creates a referral pathway to economic support services. Given the universal child health system in Sweden, which is freely available and has excellent coverage of the child population, implementation of the HWF model has potential to support families to access the freely available municipal budget and debt counselling and ultimately improve rates of child deprivation in Sweden.

METHODS/DESIGN

We will conduct a two-arm randomised waitlist-control superiority trial to examine the effectiveness and cost-effectiveness of the HWF model in the Sweden. A longitudinal follow-up with the cohort will explore whether any effects are maintained in the longer-term.

DISCUSSION

HWF is a collaborative and sustainable model that could maximise the effectiveness of current services to address child deprivation in Sweden. The study outlined in this protocol is the first effectiveness evaluation of the HWF model in Sweden and is a crucial step before HWF can be recommended for national implementation within the child health services.

TRIAL REGISTRATION

Clinicaltrials.gov; NCT05511961. Prospectively registered on 23 August 2022. https://clinicaltrials.gov/ct2/show/NCT05511961.

A Multifaceted Intervention with Savings Incentives to Reduce Multidimensional Child Poverty: Evidence from the Bridges Study (2012-2018) in Rural Uganda

Using a randomized controlled trial design, we examine the effects of savings incentives (match rate 1:1 versus 1:2) with mentorship and financial trainings on child poverty among 1383 orphaned children (mean age 12.7 years at baseline) in rural Uganda. Given the difficulty to capture child poverty using monetary measures, we use a multidimensional class of poverty that captures four dimensions: health, assets, housing, and behavioral risks. Results show that children in treatment groups experienced reductions in poverty incidence by 10 percentage points (or deprivation score by 8 percent) relative to control group counterparts at four years post-baseline, and a higher savings incentive led to stronger effects. Further, children in treatment groups were more likely to escape the poverty trap. Finally, we assess the robustness of these results to various weighting structures. This study offers a unique evidence on effectiveness of a multifaceted intervention targeting children in alleviating poverty.

Unequal From the Start? Poverty Across Immigrant Generations of Hispanic Children

Recent cohorts of U.S. children increasingly consist of immigrants or the immediate descendants of immigrants, a demographic shift that has been implicated in high rates of child poverty. Analyzing data from the 2014-2018 Current Population Survey and using the U.S. Census Bureau's Supplemental Poverty Measure, we describe differences in child poverty rates across immigrant generations and assess how these disparities are rooted in generational differences in the prevalence and impact of key poverty risk factors. Our estimates show that poverty rates among Hispanic children are very high, particularly among first-generation children and second-generation children with two foreign-born parents. Low family employment is the most significant risk factor for poverty, but the prevalence of this risk varies little across immigrant generations. Differences in parental education account for the greatest share of observed intergenerational disparities in child poverty. Supplemental comparisons with third+-generation non-Hispanic White children underscore the disadvantages faced by all Hispanic children, highlighting the continued salience of race and ethnicity within the U.S. stratification system. Understanding the role of immigrant generation vis-à-vis other dimensions of inequality has significant policy implications given that America's population continues to grow more diverse along multiple social axes.

How to Assess the Child Poverty and Distributional Impact of COVID-19 Using Household Budget Surveys: An Application Using Turkish Data

This study presents a methodology to predict the child poverty impact of COVID-19 that can be readily applied in other country contexts where similar household data are available-and illustrates this case using data from Turkey. Using Household Budget Survey 2018, the microsimulation model estimates the impact of labour income loss on household expenditures, considering that some types of jobs/sectors may be more vulnerable than others to the COVID-19 shock. Labour income loss is estimated to lead to reductions in monthly household expenditure using an income elasticity model, and expenditure-based child poverty is found to increase in Turkey by 4.9-9.3 percentage points (depending on shock severity) from a base level of 15.4%. Among the hypothetical cash transfer scenarios considered, the universal child grant for 0-17 years old children was found to have the highest child poverty reduction impact overall, while schemes targeting the bottom 20-30% of households are more cost-effective in terms of poverty reduction. The microsimulation model set out in this paper can be readily replicated in countries where similar Household Budget Surveys are available.

Children in Monetary Poor Households: Baseline and COVID-19 Impact for 2020 and 2021

The impact of the global economic crisis caused by the COVID-19 pandemic will not affect all children equally: those in poorer households and children who are disadvantaged face the most serious consequences. As parents lose their jobs and incomes, the impact on children living in impoverished households must be measured. In this article, we assess the economic consequences of the pandemic on these children. Given that poorer families have a larger number of children than other families, the analysis first establishes the proportion of children living in monetary poor households, as defined by national standards, across developing countries. Then, using historical changes and trends of income distribution per country, the latest projections about economic decline due to the pandemic, and demographic information about the distribution of children by deciles, we estimate the expected increase in the number of children in monetary poor households in developing countries as of end of 2020 to be an additional 122-144 million and, at best, a moderate decline in these numbers by end of 2021.

Lower neural value signaling in the prefrontal cortex is related to childhood family income and depressive symptomatology during adolescence

Lower family income during childhood is related to increased rates of adolescent depression, though the underlying mechanisms are poorly understood. Evidence suggests that individuals with depression demonstrate hypoactivation in brain regions involved in reward learning and decision-making processes (e.g., portions of the prefrontal cortex). Separately, lower family income has been associated with neural alterations in similar regions. Motivated by this research, we examined associations between family income, depression, and brain activity during a reward learning and decision-making fMRI task in a sample of adolescents (full n = 94; usable n = 78; mean age = 15.2 years). We focused on brain activity for: 1) expected value (EV), the learned subjective value of an object, and 2) prediction error, the difference between EV and the actual outcome received. Regions of interest related to reward learning were examined in connection to childhood family income and parent-reported adolescent depressive symptoms. As hypothesized, lower activity in the subgenual anterior cingulate (sACC) for EV in response to approach stimuli was associated with lower childhood family income, as well as greater symptoms of depression measured one-year after the neuroimaging session. These results are consistent with the hypothesis that lower early family income leads to disruptions in reward and decision-making brain circuitry, contributing to adolescent depression.

The Efficacy of Cash Supports for Children by Race and Family Size: Understanding Disparities and Opportunities for Equity

More than one-third of US children live in families with three or more children. The contemporary impact of larger family size on children's family resources remains an under-explored point of inequity. Larger family size is not only more common among Black and Hispanic children, but Black and Hispanic children in larger families (Black children, especially so) face higher poverty risks relative to White children in larger families. This analysis uses children's number of siblings and children's race and ethnicity to chart the intersectional aspects of disparity in the risk and incidence of poverty and the anti-poverty effects of large federal cash supports, the Earned Income Tax Credit and Child Tax Credit. It draws upon 2014-2017 Current Population Survey data and the NBER TAXSIM calculator to apply 2018 tax law, inclusive of the Tax Cuts and Jobs Act of 2017. It reveals well-documented disparities in poverty rates and benefit access and receipt experienced by children of color are further exacerbated by policy structures that discriminate against an under-acknowledged aspect of children's family life: their family size. Racial bias in policy design that sees tax credit access mechanisms and earnings and benefit structures disproportionately exclude that Black and Hispanic children also disproportionately exclude Black and Hispanic children by their family size. Without reforms that tackle both inequities, policy action that closes the poverty gap between larger and smaller families will see the racial gap in child poverty remain.

The impact of public assistance on child mental health in Japan: results from A-CHILD study

Public assistance is one option for providing a safety net to protect the health of children, but assistance may also generate feelings of shame that impact self-esteem. This study aims to elucidate the impact of public assistance on child mental health. We used cross-sectional data on 6920 first graders from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study. We found children living in relative poverty had more behavioral problems, low resilience, and were likely to refuse to go to school. After propensity-score matching among low-income households, the likelihood of children refusing to go to school was larger in the families receiving assistance as compared to non-recipients (OR 4.00, 95% CI 0.85-18.84) although there were no significant differences between recipients and non-recipients in low-income households. Our study produced insufficient evidence to indicate that social assistance is associated with child mental health, resilience, or school refusal.

Reducing poverty among children: Evidence from state policy simulations

State approaches to reducing child poverty vary considerably. We exploit this state-level variation to estimate what could be achieved in terms of child poverty if all states adopted the most generous or inclusive states' policies. Specifically, we simulate the child poverty reductions that would occur if every state were as generous or inclusive as the most generous or inclusive state in four key policies: Supplemental Nutrition Assistance Program (SNAP), state Earned Income Tax Credits (EITC), Temporary Assistance for Needy Families (TANF), and state Child Tax Credits (CTC). We find that adopting the most generous or inclusive state EITC policy would have the largest impact on child poverty, reducing it by 1.2 percentage points, followed by SNAP, TANF, and lastly state CTC. If all states were as generous or inclusive as the most generous or inclusive state in all four policies, the child poverty rate would decrease by 2.5 percentage points, and five and a half million children would be lifted out of poverty.

Austerity policy and child health in European countries: a systematic literature review

Background

To analyse the impact of austerity measures taken by European governments as a response to the 2008 economic and financial crisis on social determinants on child health (SDCH), and child health outcomes (CHO).

Methods

A systematic literature review was carried out in Medline (Ovid), Embase, Web of Science, PsycInfo, and Sociological abstracts in the last 5 years from European countries. Studies aimed at analysing the Great Recession, governments’ responses to the crisis, and its impact on SDCH were included. A narrative synthesis of the results was carried out. The risk of bias was assessed using the STROBE and EPICURE tools.

Results

Fourteen studies were included, most of them with a low to intermediate risk of bias (average score 72.1%). Government responses to the crisis varied, although there was general agreement that Greece, Spain, Ireland and the United Kingdom applied higher levels of austerity. High austerity periods, compared to pre-austerity periods were associated with increased material deprivation, child poverty rates, and low birth weight. Increasing child poverty subsequent to austerity measures was associated with deterioration of child health. High austerity was also related to poorer access and quality of services provided to disabled children. An annual reduction of 1% on public health expenditure was associated to 0.5% reduction on Measles-Mumps-Rubella vaccination coverage in Italy.

Conclusions

Countries that applied high level of austerity showed worse trends on SDCH and CHO, demonstrating the importance that economic policy may have for equity in child health and development. European governments must act urgently and reverse these austerity policy measures that are detrimental to family benefits and child protection.

The development of episodic foresight in preschoolers: the role of socioeconomic status, parental future orientation, and family context

Episodic foresight (EF) refers to the ability to anticipate future states of the self. Despite almost two decades of research, no studies explored how family context variables relate to the development of this ability. The objectives of this study were to explore the association of socioeconomic status (SES), parental consideration of future consequences (CFC), and family environment quality on the development of episodic foresight and to compare the magnitude of the effects of these same variables on delay of gratification and planning.Sixty-four dyads composed by 4-year-old Uruguayan children and their main caregiver participated in the study. Children were administered experiments on episodic foresight, delay of gratification, planning, and receptive language. Parents reported socioeconomic status, family environment, and their consideration of future consequences. Even though parents' limit setting was associated to higher EF in children and parental CFC-I was a predictor in multiple regression analysis, these effects ceased to be significant when controlled by child's receptive language and caregiver education, being these the main predictors of EF. Results also indicate that SES significantly distinguishes the performance in future-oriented skills and language, being the magnitude of the effect higher for EF in comparison with planning and delay of gratification. This study supports that EF is related to SES to a greater extent than other variables traditionally assessed in studies of poverty and child development. We discuss implications of low SES and language skills in the light of EF development and immediate-oriented behavior in contexts of deprivation.

Poverty, economic strengthening, and mental health among AIDS orphaned children in Uganda: Mediation model in a randomized clinical trial

Some evidence points to the positive effects of asset accumulation programs on mental health of children living in low-resource contexts. However, no evidence exists as to why and how such impact occurs. Our study aims to understand whether child poverty, child work, and household wealth serve as pathways through which the economic strengthening intervention affects the mental health of AIDS-orphaned children. The study employed a cluster-randomized experimental design with a family-based economic strengthening intervention conducted among 1410 school-going AIDS-orphaned children ages 10 and 16 years old in 48 primary schools in South Western Uganda. To test the hypothesized relationships between the intervention, mediators (household wealth, child poverty, and child's work) and mental health, we ran structural equation models that adjust for clustering of individuals within schools and account for potential correlation among the mediators. We found significant unmediated effect of the intervention on children's mental health at 24 months (B = -0.59; 95% CI: 0.93, -0.25; p < 0.001; β = -0.33). Furthermore, the results suggest that participation in the intervention reduced child poverty at 12 months, which in turn improved latent mental health outcome at 24 months (B = -0.14; 95% CI: -0.29, -0.01; p < 0.06; β = -0.08). In addition, though not statistically significant at the 0.05 level, at 36 and 48 months, mental health of children in the treatment group improved by 0.13 and 0.16 standard deviation points correspondingly with no evidence of mediation. Our findings suggest that anti-poverty programs that aim solely to improve household income may be less advantageous to children's mental health as compared to those that are specifically targeted towards reducing the impact of poverty on children. Further studies using more comprehensive measures of child work and age-appropriate child mental health may shed more light on understanding the link between asset accumulation interventions, child labor and children's mental health.

Exploring the relationship between welfare participation in childhood and depression in adulthood in the United States

OBJECTIVE

Depression is a serious mental health disorder, and untangling its causal agents is a major public health priority in the United States. This study examines the relationship between participating in welfare programs during childhood and experiencing depression during young adulthood.

METHOD

This study used wave I and IV data from the Add Health (N = 15,701). Multiple imputation is used to deal with missing data. Propensity score matching is used to reduce the selection bias, and then multiple regressions were used to examine the welfare participation and depression relationships.

RESULTS

Overall, young adults from welfare-recipient families reported significantly higher depression scores, rather than the clinical diagnosis of depression. Subgroup analyses showed only the poor group had significantly higher depression scores, whereas only the near-poor group had a significantly diagnosed depression outcome. Additionally, significantly higher depression scores were found for female youth from welfare-recipient families. However, no significant differences were found between the gender groups regarding diagnosed depression.

DISCUSSION

Using welfare participation as an economic marker, the subgroup analyses help to identify target populations for future intervention. Implications of this study will be of interest to policy makers and have value for informing policy decisions.

Child Poverty, Toxic Stress, and Social Determinants of Health: Screening and Care Coordination

Social determinants of health (SDOH) refer to the social, economic, and physical conditions in which people live that may affect their health. Poverty, which affects nearly 15 million children in the United States, has far-reaching effects on children's physical and mental health. Although it is difficult to change a family's economic circumstances, nurses can play a critical role to address SDOH through screening and effective coordination of care. As nurses, our role is to minimize the effects of SDOH, including poverty, on child health and well-being through our practice, research, and professional education. We present three exemplars of child poverty to demonstrate the impact on child health and well-being and propose a model of care for nurses to assess and address SDOH in the pediatric clinical setting.

Mediating effects of parental psychological distress and individual-level social capital on the association between child poverty and maltreatment in Japan

Child poverty is well known as a major risk factor for child maltreatment. However, it is not known whether parental psychological distress and individual-level social capital mediate the association. We examined the mediation effect of these two factors on the association between child poverty and maltreatment. In the Adachi Child Health Impact of Living Difficulty (A-CHILD) Study, a questionnaire was administered to all caregivers of first-grade children in every public elementary school in Adachi City between July and November 2015, and valid responses were used for analysis (N = 3944). Logistic and Poisson regression analyses were employed to examine the association between child poverty and maltreatment. Child poverty was defined in this study as meeting one of these criteria: 1) household income less than 3 million yen; 2) deprivation of specific material items that children or the household requires, or 3) experience of being unable to pay for lifeline utilities. Child maltreatment (physical abuse, neglect, and psychological abuse) was answered by parents. We confirmed a robust association between child poverty and maltreatment. Mediation analysis indicated that parental psychological distress mediated more than 60% of the association between child poverty on physical abuse and psychological abuse, while individual-level social capital mediated only 10% of the association with any type of maltreatment. In addition, structural equation modeling analysis revealed that the association was mediated by both parental psychological distress and social capital simultaneously. The findings suggest that supporting parental psychological distress may be an effective intervention to remedy the negative impact of child poverty on maltreatment.

Empirical evidence of child poverty and deprivation in Nigeria

Development economists and policy makers have in recent times focused attention on child poverty as a crucial aspect of poverty. The importance of the analysis of child poverty partly lies in the fact that children are the most vulnerable group in every society. This study used two poverty lines and the Foster-Greer-Thorbecke index to analyze extreme and overall child poverty headcount, depth and severity in Nigeria. The study also used the headcount ratio to analyze the extent of child deprivation in education, health, nutrition, child protection, water and sanitation. The study was based on the 2010 Harmonized Nigeria Living Standard Survey (HNLSS) and the 2011 Multiple Indicator Cluster Survey (MICS), obtained from the National Bureau of Statistics (NBS), Abuja, Nigeria. The study revealed that 23.22% of children in Nigeria were in extreme child poverty while 70.31% of children in the country were in overall child poverty. The study further showed that there was pronounced child deprivation in education, health, nutrition, child protection, water and sanitation. Both child poverty and child deprivation were more pronounced in the rural sector than in the urban sector and in Northern Nigeria than in Southern Nigeria. Therefore, the Nigerian government should take adequate steps to eradicate child poverty and obliterate all forms of child deprivation in Nigeria - particularly deprivation in basic needs. In taking such steps, more attention should be focused on rural areas and Northern Nigeria.

Cumulative adversity, childhood behavioral problems, and educational mobility in China's poorest rural communities

Behavioral problems are recognized as playing a potentially important role in educational attainment, but their function in contexts of extreme poverty is not well understood. In such settings, other factors might swamp any effects of children's behavioral problems. Further, the interpretation of behavioral problems in circumstances of deep poverty is not clear: problematic behaviors might be in part a direct function of adverse experiences in childhood. In this paper, we focus on the case of 2000 rural youth sampled in the year 2000 from 100 villages in Gansu, one of China's poorest provinces, and followed up through 2015. We investigate whether behavioral problems-internalizing problems, externalizing problems, and teacher-reported behavior problems-predict subsequent educational attainment among the rural poor, and consider the contributions of cumulative adversity to behavioral problems. Results in a high-poverty context where promotion decisions are closely tied to performance show that behavioral factors are linked to long-term educational outcomes. These results are robust to adjustment for a host of individual, family, and community context variables. There is some evidence that children in higher socioeconomic status families and in more developed communities are less vulnerable to behavioral problems. While girls are slightly less vulnerable to teacher-reported behavior problems than boys, there is no gender difference in the implications of behavioral problems for educational attainment. Finally, behavioral problems do not appear to operate simply as a proxy for measured family adversity.

Poverty and child health in the UK: using evidence for action

There are currently high levels of child poverty in the UK, and for the first time in almost two decades child poverty has started to rise in absolute terms. Child poverty is associated with a wide range of health-damaging impacts, negative educational outcomes and adverse long-term social and psychological outcomes. The poor health associated with child poverty limits children's potential and development, leading to poor health and life chances in adulthood. This article outlines some key definitions with regard to child poverty, reviews the links between child poverty and a range of health, developmental, behavioural and social outcomes for children, describes gaps in the evidence base and provides an overview of current policies relevant to child poverty in the UK. Finally, the article outlines how child health professionals can take action by (1) supporting policies to reduce child poverty, (2) providing services that reduce the health consequences of child poverty and (3) measuring and understanding the problem and assessing the impact of action.

Interactions Between Policy Effects, Population Characteristics and the Tax-Benefit System: An Illustration Using Child Poverty and Child Related Policies in Romania and the Czech Republic

We investigate the impact of the Romanian and Czech family policy systems on the poverty risk of families with children. We focus on separating out the effects of policy design itself and size of benefits from the interaction between policies and population characteristics. We find that interactions between population characteristics, the wider tax benefit system and child related policies are pervasive and large. Both population characteristics and the wider tax-benefit environment can dramatically alter the antipoverty effect of a given set of policies.

Trends in Child Poverty in Sweden: Parental and Child Reports

We use several family-based indicators of household poverty as well as child-reported economic resources and problems to unravel child poverty trends in Sweden. Our results show that absolute (bread-line) household income poverty, as well as economic deprivation, increased with the recession 1991-96, then reduced and has remained largely unchanged since 2006. Relative income poverty has however increased since the mid-1990s. When we measure child poverty by young people's own reports, we find few trends between 2000 and 2011. The material conditions appear to have improved and relative poverty has changed very little if at all, contrasting the development of household relative poverty. This contradictory pattern may be a consequence of poor parents distributing relatively more of the household income to their children in times of economic duress, but future studies should scrutinze potentially delayed negative consequences as poor children are lagging behind their non-poor peers. Our methodological conclusion is that although parental and child reports are partly substitutable, they are also complementary, and the simultaneous reporting of different measures is crucial to get a full understanding of trends in child poverty.

The dynamic relationship between cash transfers and child health: can the child support grant in South Africa make a difference to child nutrition?

Objective

Cash transfer programmes targeting children are considered an effective strategy for addressing child poverty and for improving child health outcomes in developing countries. In South Africa, the Child Support Grant (CSG) is the largest cash transfer programme targeting children from poor households. The present paper investigates the association of the duration of CSG receipt with child growth at 2 years in three diverse areas of South Africa.

Design

The study analysed data on CSG receipt and anthropometric measurements from children. Predictors of stunting were assessed using a backward regression model.

Setting

Paarl (peri-urban), Rietvlei (rural) and Umlazi (urban township), South Africa, 2008.

Subjects

Children (n 746), median age 22 months.

Results

High rates of stunting were observed in Umlazi (28 %), Rietvlei (20 %) and Paarl (17 %). Duration of CSG receipt had no effect on stunting. HIV exposure (adjusted OR=2·30; 95 % CI 1·31, 4·03) and low birth weight (adjusted=OR 2·01, 95 % CI 1·02, 3·96) were associated with stunting, and maternal education had a protective effect on stunting.

Conclusions

Our findings suggest that, despite the presence of the CSG, high rates of stunting among poor children continue unabated in South Africa. We argue that the effect of the CSG on nutritional status may have been eroded by food price inflation and limited progress in the provision of other important interventions and social services.

Universalism under siege? Exploring the association between targeting, child benefits and child poverty across 26 countries

The long-standing wisdom that universally designed benefits outperform targeted benefits in terms of poverty reduction has come under siege. Recent empirical studies tend to find that targeting is not necessarily associated anymore with lower levels of poverty reduction. In this study, we investigate for a broad set of European countries (1) the relationship between child benefits and child poverty reduction; (2) whether a universal or targeted approach is more effective in reducing child poverty; and (3) the causal mechanisms explaining the link between (1) and (2). In doing so, we take into account the general characteristics of the child benefit system, the size of the redistributive budget and the generosity of benefit levels. In contrast to previous studies, we construct an indicator of targeting that captures the design instead of the outcomes of child benefit systems. We find that targeting towards lower incomes is associated with higher levels of child poverty reduction, conditional on the direction of targeting and the characteristics of the benefit system.

Oh Canada! Too many children in poverty for too long

Despite continued economic growth, Canada's record on child poverty is worse than it was in 1989, when the House of Commons unanimously resolved to end child poverty by the year 2000. Most recent data indicate that nearly 1.2 million children - almost one of every six children - live in low-income households. Campaign 2000 contends that poverty and income inequality are major barriers to the healthy development of children, the cohesion of our communities and, ultimately, to the social and economic well-being of Canada. Canada needs to adopt a poverty-reduction strategy that responds to the UNICEF challenge to establish credible targets and timetables to bring the child poverty rate well below 10%, as other Organisation for Economic Co-operation and Development nations have done. Campaign 2000 calls on the federal government to develop a cross-Canada poverty-reduction strategy in conjunction with the provinces, territories and First Nations, and in consultation with low-income people. This strategy needs to include good jobs at living wages that ensure that full-time work is a pathway out of poverty; an effective child benefit of $5,100 that is indexed; a system of affordable, universally accessible early learning and child care services available to all families irrespective of employment status; an affordable housing program that creates more affordable housing and helps to sustain existing stock; and affordable and accessible postsecondary education and training programs that prepare youth and adults for employment leading to economic independence.

Tracking exposure to child poverty during the first 10 years of life in a Quebec birth cohort

OBJECTIVES

Early childhood poverty is associated with adult chronic diseases. The objectives of this study were to examine patterns of exposure to poverty during the first 10 years of life in the Quebec Longitudinal Study of Child Development (QLSCD) cohort according to three measures of poverty and to explore family characteristics associated with different poverty exposures.

METHOD

Data from 1,334 participants from the QLSCD were collected annually at home from ages 5 months through 10 years. Household income (previous 12 months) and sources of income were recorded at each data round. Poverty status was operationalized as 1) living below the low income cut-off of Statistics Canada, 2) receiving social welfare and 3) being in the lowest quintile of socio-economic status. We plotted trends in the prevalence of child poverty over time. We used latent class growth modelling to identify subgroups with similar poverty trajectories. Duration of poverty according to each measure was computed separately for early childhood, middle childhood, and the entire 10 years of life.

RESULTS

Four trajectories of poverty were identified: stable poor, decreasing likelihood, increasing likelihood, and never poor. The three measures of poverty do not cover the same population, yet the characteristics of those identified as poor are similar. Children of non-European, immigrant mothers were most likely to be poor, and there was a higher likelihood of children from single-parent families to live in chronic poverty during the first 10 years.

CONCLUSION

A large proportion of children are exposed to poverty before 10 years of age. More effective public policies could reduce child poverty.