Psychosocial predictors of being an underweight infant differ by racial group: a prospective study of Louisiana WIC program participants

Maternal education and its influence on child growth and nutritional status during the first two years of life: a systematic review and meta-analysis

Background

The first 1000 days of life are critical for a child's health and development. Impaired growth during this period is linked to increased child morbidity, mortality, and long-term consequences. Undernutrition is the main cause, and addressing it within the first 1000 days of life is vital. Maternal education is consistently identified as a significant predictor of child undernutrition, but its specific impact remains to be determined. This study presents a systematic review and meta-analysis investigating the influence of high versus low maternal education levels on child growth from birth to age two, using population-based cohort studies.

Methods

Databases including PubMed, Scopus, EMBASE, Web of Science, ERIC, and Google Scholar were searched from January 1990 to January 2024 using appropriate search terms. We included population-based cohort studies of healthy children aged two years and under and their mothers, categorizing maternal education levels. Child growth and nutritional outcomes were assessed using various indicators. Two reviewers independently conducted data extraction and assessed study quality. The Newcastle Ottawa scale was utilized for quality assessment. Random-effects models were used for meta-analysis, and heterogeneity was assessed using the Cochrane Q and I2 statistic. Subgroup and sensitivity analyses were performed, and publication bias was evaluated.

Findings

The literature search retrieved 14,295 titles, and after full-text screening of 639 reports, 35 studies were included, covering eight outcomes: weight for age z-score (WAZ), height for age z-score (HAZ), BMI for age z-scores (BMIZ), overweight, underweight, stunting, wasting, and rapid weight gain. In middle-income countries, higher maternal education is significantly associated with elevated WAZ (MD 0.398, 95% CI 0.301-0.496) and HAZ (MD 0.388, 95% CI 0.102-0.673) in children. Similarly, in studies with low-educated population, higher maternal education is significantly linked to increased WAZ (MD 0.186, 95% CI 0.078-0.294) and HAZ (0.200, 95% CI 0.036-0.365). However, in high-income and highly educated population, this association is either absent or reversed. In high-income countries, higher maternal education is associated with a non-significant lower BMI-Z (MD -0.028, 95% CI -0.061 to 0.006). Notably, this inverse association is statistically significant in low-educated populations (MD -0.045, 95% CI -0.079 to -0.011) but not in highly educated populations (MD 0.003, 95% CI -0.093 to 0.098).

Interpretation

Maternal education's association with child growth varies based on country income and education levels. Further research is needed to understand this relationship better.

Funding

This study was a student thesis supported financially by Tehran University of Medical Sciences (TUMS).

Recovery in Young Children with Weight Faltering: Child and Household Risk Factors

OBJECTIVE

To examine whether weight recovery among children with weight faltering varied by enrollment age and child and household risk factors.

STUDY DESIGN

Observational, conducted in an interdisciplinary specialty practice with a skill-building mealtime behavior intervention, including coaching with video-recorded interactions. Eligibility included age 6-36 months with weight/age

RESULTS

Enrolled 286 children (mean age 18.8 months, SD 6.8). Significant weight/age recovery occurred regardless of risk index or age. Mean weight/age z-score change was significantly greater among younger compared with older age (0.29 vs 0.17, P = .03); top household risk quartile compared with reference (0.34 vs 0.22, P = .046); and marginally greater among top child risk quartile compared with reference (0.37 vs 0.25, P = .058). Mean weight/age z-score change was not associated with single risk factors or interactions; greatest weight gain occurred in most underweight children.

CONCLUSIONS

Weight recovery over 6 months was statistically significant, although modest, and greater among younger children and among children with multiple child and household risk factors. Findings support differential susceptibility theory, whereby some children with multiple risk factors are differentially responsive to intervention. Future investigations should evaluate components of the mealtime behavior intervention.

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Key Words

• failure-to-thrive
• differential susceptibility theory
• child growth
• intervention
• responsive feeding
• mealtime habits

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MESH Headings

• Behavior Therapy/methods
• Caregivers/psychology
• Child Behavior
• Child, Preschool
• Failure to Thrive/etiology
• Failure to Thrive/psychology
• Failure to Thrive/therapy
• Feeding Behavior
• Female
• Humans
• Infant
• Infant Behavior
• Linear Models
• Male
• Risk Factors
• Self Efficacy
• Thinness/etiology
• Thinness/psychology
• Thinness/therapy
• Treatment Outcome

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Grants

• R01 HD056099 NICHD NIH HHS

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Affiliation(s)

Maureen M Black Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD.
Nicholas Tilton Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
Samantha Bento Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
Pamela Cureton Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
Susan Feigelman Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD

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Diagnosis and surgical delays in African American and white women with early-stage breast cancer

BACKGROUND

Delays in diagnosis and treatment for breast cancer may contribute to excess deaths among African Americans. We examined racial differences in delays in diagnosis and surgical treatment for early-stage breast cancer and evaluated race-specific predictors associated with delay.

METHODS

A retrospective cohort study was conducted among 634 African American and white women diagnosed with invasive breast cancer between 2005 and 2010 in New Jersey. Detailed medical-chart abstraction and patient interviews were undertaken. Time intervals were calculated from symptom recognition to diagnosis (diagnosis delay) and from diagnosis to first operation (surgical delay). Binomial regression models were used to examine racial differences in delay and factors associated with ≥2 months delay in the overall population and stratified by race. Reasons responsible for diagnosis delay were also examined by race.

RESULTS

Compared to white women, African American women experienced significantly higher risk of ≥2 months delay in diagnosis and surgical treatment (adjusted relative risks=1.44 (1.12-1.86) and 3.08 (1.88-5.04), respectively). For the African Americans, predictors of diagnosis delay included mode of detection, insurance, and tumor size; for whites, mode of detection and tumor grade. Surgical delay was associated with operation type and education among African Americans but with operation type and tumor size for whites. Patient-related factors were commonly noted as reasons for diagnosis delay.

CONCLUSIONS

These findings emphasize the need to raise further awareness, especially among African American patients and their providers, of the importance of prompt evaluation and treatment of breast abnormalities. Research on effective ways to accomplish this is needed.

Conquering racial disparities in perinatal outcomes

Infant mortality rate (IMR) is a reference indicator for societal health status. Trend analysis of IMR highlights 2 challenges to overcome in the United States: (1) US IMR is higher than most industrialized countries and (2) there are persistent racial/ethnic disparities in birth outcomes, especially for blacks. Racial/ethnic infant mortality disparities result from the complex interplay of adverse social, economic, and environmental exposures. In this article, racial/ethnic disparities are discussed, highlighting trends, the role of epigenetics in understanding mechanisms, key domains of community action planning, and programs and policies addressing the racial gaps in adverse birth outcomes.

Targeted health department expenditures benefit birth outcomes at the county level

BACKGROUND

Public health leaders lack evidence for making decisions about the optimal allocation of resources across local health department (LHD) services, even as limited funding has forced cuts to public health services while local needs grow. A lack of data has also limited examination of the outcomes of targeted LHD investments in specific service areas.

PURPOSE

This study used unique, detailed LHD expenditure data gathered from state health departments to examine the influence of maternal and child health (MCH) service investments by LHDs on health outcomes.

METHODS

A multivariate panel time-series design was used in 2013 to estimate ecologic relationships between 2000-2010 LHD expenditures on MCH and county-level rates of low birth weight and infant mortality. The unit of analysis was 102 LHD jurisdictions in Washington and Florida.

RESULTS

Results indicate that LHD expenditures on MCH services have a beneficial relationship with county-level low birth weight rates, particularly in counties with high concentrations of poverty. This relationship is stronger for more targeted expenditure categories, with expenditures in each of the three specific examined MCH service areas demonstrating the strongest effects.

CONCLUSIONS

Findings indicate that specific LHD investments in MCH have an important effect on related health outcomes for populations in poverty and likely help reduce the costly burden of poor birth outcomes for families and communities. These findings underscore the importance of monitoring the impact of these evolving investments and ensuring that targeted, beneficial investments are not lost but expanded upon across care delivery systems.

Local public health delivery of maternal child health services: are specific activities associated with reductions in Black-White mortality disparities?

To identify which MCH services delivered by local health departments (LHD) appear associated with reducing differences in Black-White mortality. We used a time-trend design to investigate relationships between change in MCH activities provided by LHDs in 1993 and in 2005 and changes in 1993-2005 Black-White mortality disparities. Secondary data were analyzed for 558 US counties and multi-county districts. Independent variables included the six MCH services provided by LHDs and captured in the 1993 and 2005 NACCHO Profile of Local Public Health Departments surveys. MCH service variables represented change in each service from 1993 to 2005. Control variables included selected LHD characteristics and county-level socioeconomic, demographic, and health provider resource data. Absolute change in Black and White mortality rates and changes in the mortality disparity "gap" between these rates in 1993 and 2005 were examined as dependent variables. Among the MCH services examined, prenatal care had a significant beneficial relationship with Black all-age mortality change and with reducing the mortality "gap." Family planning services had a beneficial relationship with reducing the mortality "gap" for females in the jurisdictions in the study sample. WIC services indicated the most consistently beneficial relationship with both Black mortality and White mortality change, but these changes did not influence the mortality "gap" during the study period. LHD delivery of family planning and prenatal care by LHDs appears related to reductions in Black-White mortality disparities. Implications of this study suggest the importance of certain MCH services for reducing Black-White mortality disparities.