Nutrient-Level Evaluation of Meals Provided on the Government-Funded School Lunch Program in New Zealand

Approximately 1 in 6 children in New Zealand are living in households facing poverty and 14% of the population is food insecure. The Ka Ora, Ka Ako|Healthy School Lunches program aims to reduce food insecurity by providing access to a nutritious lunch every school day. This study analyzed the nutritional content of Ka Ora, Ka Ako meals and compared them to national and international standards. Meals were selected at random from approved menus. The suppliers covered by the 302 meals analyzed provide 161,699 students with a lunch (74.9% of students on the program). The meals were analyzed using Foodworks 10 nutrient analysis software. The nutrient content was compared against the New Zealand/Australia Nutrient Reference Values (NRVs) and to nutrient-level standards for international school lunch programs. A total of 77.5% of nutrients analyzed exceeded 30% of the recommended daily intakes. Protein, vitamin A and folate met the NRV targets and a majority of the international standards (55/57). Energy, calcium, and iron were low compared to NRVs and international standards (meeting 2/76 standards). Carbohydrates were low compared to international standards. The findings have been used to inform the development of revised nutrition standards for the program, which will be released in 2022.

Whole Child Well-Child Visits: Implementing ACEs and SDOH Screenings in Primary Care

Adverse childhood experiences (ACEs) and social determinants of health (SDOH) negatively affect health outcomes. This program was developed to screen for ACEs and SDOH in the primary care setting in families with children 9 months to 5 years of age at well-child checks and provide interventions that support families and build resiliency. Programmatic criteria were identified, referral resources were developed, and a database was implemented, with 246 families enrolled in year 1; 56.9% of caregivers reported 1 or more ACEs for their child, 63% of caregivers reported an SDOH need, and 39.4% of caregivers reported both. The average number of ACEs was 0.94. This program was created to address ACEs and SDOH, to empower families, build resiliency, and provide buffers to mitigate and prevent ACEs. It provides a model that can be implemented in a primary care setting while providing wraparound resources, including integrated mental health resources and referrals, to measure the success of these interventions.

Childhood poverty and psychological well-being: The mediating role of cumulative risk exposure

The current study assessed whether the proportion of childhood (age 0-9 years) in poverty altered the developmental trajectories (ages 9-24) of multimethodological indicators of psychological well-being. In addition, we tested whether exposure to cumulative risk over time mediated the association between poverty exposure and psychological well-being. Measures of psychological well-being included internalizing and externalizing symptoms, a behavioral index of learned helplessness (task persistence), and chronic physiological stress (allostatic load). Exposure to poverty during childhood predicted the trajectory of each development outcome: individuals with more poverty exposure during childhood showed (a) relatively high levels of internalizing symptoms that diminished more slowly with maturation, (b) relatively high levels of externalizing symptoms that increased faster over time, (c) less task persistence indicative of greater learned helplessness, and (d) higher levels of chronic physiological stress which increased faster over time relative to persons with less childhood poverty exposure. Trajectories of cumulative risk exposure from physical and psychosocial surroundings from 9-24 years accounted for the association between childhood poverty and the growth curves of internalizing and externalizing symptoms but not for learned helplessness or chronic physiological stress. Additional sensitivity analyses indicate that early childhood disadvantage is particularly problematic for each outcome, except for internalizing symptoms which seem sensitive to the combination of early and lifetime poverty exposure. We also explored whether domains of cumulative risk as well as two alternatives, maternal sensitivity or family cohesion, functioned as mediators. Little evidence emerged for any of these alternative mediating constructs.

The New Patterns study: coordinated measures to combat child poverty

Background

Child poverty rates are rising in Norway with potential negative consequences for children. Services for families with low income are often fragmented and poorly integrated, and few coordinated initiatives have been implemented and evaluated in Norway.

Aims:

The aim of the current study is to evaluate how integrated and coordinated services provided over a prolonged period by a family coordinator are related to changes across a wide range of health, wellbeing and home environment indicators for the participants.

Methods:

The study uses a mixed methods approach utilising survey and register data, as well as information from interviews and shadowing, to document and evaluate outcomes associated with the intervention and the process of implementation. Data are gathered at baseline and annually throughout the duration of the study. Participants are identified to facilitate longer-term follow-up using register data.

Conclusions:

This project will develop important knowledge about the implementation of coordinated services to families with a low income, and how this way of organizing services influences important outcomes for the family members in the short and long term.

Prospective associations, longitudinal patterns of childhood socioeconomic status, and white matter organization in adulthood

The association between childhood socioeconomic status (SES) and brain development is an emerging area of research. The primary focus to date has been on SES and variations in gray matter structure with much less known about the relation between childhood SES and white matter structure. Using a longitudinal study of SES, with measures of income-to-needs ratio (INR) at age 9, 13, 17, and 24, we examined the prospective relationship between childhood SES (age 9 INR) and white matter organization in adulthood using diffusion tensor imaging. We also examined how changes in INR from childhood through young adulthood are associated with white matter organization in adult using a latent growth mixture model. Using tract-based spatial statistics (TBSS) we found that there is a significant prospective positive association between childhood INR and white matter organization in the bilateral uncinate fasciculus, bilateral cingulum bundle, bilateral superior longitudinal fasciculus, and corpus callosum (p < .05, FWE corrected). The probability that an individual was in the high-increasing INR profile across development compared with the low-increasing INR profile was positively associated with white matter organization in the bilateral uncinate fasciculus, left cingulum, and bilateral superior longitudinal fasciculus. The results of the current study have potential implications for interventions given that early childhood poverty may have long-lasting associations with white matter structure. Furthermore, trajectories of socioeconomic status during childhood are important-with individuals that belong to the latent profile that had high increases in INR having greater regional white matter organization in adulthood.

Desirability of Clinic-Based Financial Services in Urban Pediatric Primary Care

OBJECTIVES

To determine the desirability of integrating financial services in pediatric primary care among caregivers and older adolescents.

STUDY DESIGN

We conducted a cross-sectional study among caregivers and late adolescents 18 years and older attending an urban, pediatric primary care clinic.

RESULTS

The 221 participants had a mean age of 32.1 years, with 28% of the sample aged 18-25 years. The majority were African American (90.1%), female (83.3%), and single parents (55.1%). More than one-third of the participants (35.8%) reported no household earned income, and 26.7% had a yearly household total income of <$12,000. More than one-half (61.5%) reported financial stress in general, and 67.9% believed that the clinic should provide financial services, including financial education and job workshops. A greater proportion of those who desired clinic-based services were African American (94.7% vs 75%; P < .001) and had a low or middle subjective social status (95.7% vs 83.7%; P = .01).

CONCLUSIONS

Clinic-based financial services are desired by caregivers and late adolescents in an urban pediatric primary care practice. Prospective studies are needed to assess the long-term impact of integrated services on childhood poverty and family well-being.

Childhood Brain Development, the Educational Achievement Gap, and Cognitive Enhancement

Research on the effects of adversity on the brain of children initially encountered strong skepticism mainly due to the fear of stigmatization and the potential pathologizing of poverty as a disease. Despite initial resistance, an increasing body of work demonstrates a correlation between low socioeconomic status and brain development. This article will focus specifically on the impact of poverty (material, economic, and social) on childhood brain development and educational achievement. Some suggest that the use of cognitive enhancers in healthy students is perfectly acceptable and should be promoted to counterbalance the failure of traditional means to improve educational achievements. In this article, I critically assess the claim that a broad use of cognitive enhancers should be promoted and offer an alternative approach. The first section evaluates the neuroscientific facts and evidence of the impact of poverty on brain development and outlines some of the criticisms raised against the “neuroscience of poverty.” The second section focuses on the proposal made by Ray (2016) that promotes the use of cognitive enhancers as a means to address poor educational attainment. I criticize the basis of her argument and propose a different approach I call the clinical ideal. Subsequently, I provide some ethical pointers to allow an ethical and prudent use of cognitive enhancers in the educational setting. The main point of the article is not to reject prima facie the use of cognitive enhancers in socially disadvantaged students but rather provide a more nuanced approach.

Neuroscience of Childhood Poverty: Evidence of Impacts and Mechanisms as Vehicles of Dialog With Ethics

Several studies have identified associations between poverty and development of self-regulation during childhood, which is broadly defined as those skills involved in cognitive, emotional, and stress self-regulation. These skills are influenced by different individual and contextual factors at multiple levels of analysis (i.e., individual, family, social, and cultural). Available evidence suggests that the influences of those biological, psychosocial, and sociocultural factors on emotional and cognitive development can vary according to the type, number, accumulation of risks, and co-occurrence of adverse circumstances that are related to poverty, the time in which these factors exert their influences, and the individual susceptibility to them. Complementary, during the past three decades, several experimental interventions that were aimed at optimizing development of self-regulation of children who live in poverty have been designed, implemented, and evaluated. Their results suggest that it is possible to optimize different aspects of cognitive performance and that it would be possible to transfer some aspects of these gains to other cognitive domains and academic achievement. We suggest that it is an important task for ethics, notably but not exclusively neuroethics, to engage in this interdisciplinary research domain to contribute analyses of key concepts, arguments, and interpretations. The specific evidence that neuroscience brings to the analyses of poverty and its implications needs to be spelled out in detail and clarified conceptually, notably in terms of causes of and attitudes toward poverty, implications of poverty for brain development, and for the possibilities to reduce and reverse these effects.

Childhood poverty and recruitment of adult emotion regulatory neurocircuitry

One in five American children grows up in poverty. Childhood poverty has far-reaching adverse impacts on cognitive, social and emotional development. Altered development of neurocircuits, subserving emotion regulation, is one possible pathway for childhood poverty's ill effects. Children exposed to poverty were followed into young adulthood and then studied using functional brain imaging with an implicit emotion regulation task focused. Implicit emotion regulation involved attention shifting and appraisal components. Early poverty reduced left dorsolateral prefrontal cortex recruitment in the context of emotional regulation. Furthermore, this emotion regulation associated brain activation mediated the effects of poverty on adult task performance. Moreover, childhood poverty also predicted enhanced insula and reduced hippocampal activation, following exposure to acute stress. These results demonstrate that childhood poverty can alter adult emotion regulation neurocircuitry, revealing specific brain mechanisms that may underlie long-term effects of social inequalities on health. The role of poverty-related emotion regulatory neurocircuitry appears to be particularly salient during stressful conditions.

Strengths and weakness of neuroscientific investigations of childhood poverty: future directions

The neuroscientific study of child poverty is a topic that has only recently emerged. In comparison with previous reviews (e.g., Hackman and Farah, 2009; Lipina and Colombo, 2009; Hackman et al., 2010; Raizada and Kishiyama, 2010; Lipina and Posner, 2012), our perspective synthesizes findings, and summarizes both conceptual and methodological contributions, as well as challenges that face current neuroscientific approaches to the study of childhood poverty. The aim of this effort is to identify target areas of study that could potentially help build a basic and applied research agenda for the coming years.

Childhood Poverty and the Transition to Adulthood

The authors used the Panel Study of Income Dynamics 2007 Transition to Adulthood data in combination with the 2002 Child Development Supplement to examine social class bifurcation in young adulthood. Results indicate that poor youth possibly take on adult roles "too early" at the same time that high-income youth may be supported for a long period past their 18^th birthday. Although not all evidence is consistent with this bifurcated story, childhood poverty does play a key role. Young adults from poor families establish financial independence early (e.g., contributing to family bills during adolescence, considering themselves fully responsible for their finances as young adults), whereas young adults from more affluent homes are more likely to receive financial transfers from their parents (who often help them pay for college and other expenses). These findings highlight the ways in which socioeconomic inequality in childhood can differentiate youth's experiences of adolescence and young adulthood.

Childhood poverty and blood pressure reactivity to and recovery from an acute stressor in late adolescence: the mediating role of family conflict

OBJECTIVE

Childhood deprivation is inimical to health throughout the life course. Early experiences of stress could play a role in health inequalities. An important aspect of childhood poverty that has not received much attention is cardiovascular reactivity to and recovery from acute stressors.

METHODS

Piecewise, multilevel growth curve regression was used to examine blood pressure reactivity to and recovery from a mental arithmetic task among late adolescents (mean [standard deviation] = 17.3 [1.0] years, n = 185) as a function of early childhood poverty (9 years). We also tested whether exposure to family conflict at age 13 years mediated expected linkages between childhood poverty and adolescent blood pressure reactivity and recovery to an acute stressor.

RESULTS

Blood pressure reactivity was unaffected by household income during childhood, but late adolescents with lower household income during childhood showed slower systolic (b = -0.29, p = .004) and diastolic (b = -0.19, p = .002) recovery. These results include age and sex as statistical covariates. The significant poverty impact on systolic but not on diastolic blood pressure recovery was mediated by exposure to family conflict (95% confidence interval = - 0.1400 to - 0.0012).

CONCLUSIONS

We show that late adolescents who grew up in poverty have delayed blood pressure recovery from an acute stressor. Furthermore, childhood exposure to family conflict, a well-documented component of early childhood deprivation, accounted for some of the adverse effects of childhood poverty on stressor recovery among these adolescents. We discuss the importance of considering physiological stress accompanying early experiences of deprivation in thinking about health inequalities.

The impact of poverty on the development of brain networks

Although the study of brain development in non-human animals is an old one, recent imaging methods have allowed non-invasive studies of the gray and white matter of the human brain over the lifespan. Classic animal studies show clearly that impoverished environments reduce cortical gray matter in relation to complex environments and cognitive and imaging studies in humans suggest which networks may be most influenced by poverty. Studies have been clear in showing the plasticity of many brain systems, but whether sensitivity to learning differs over the lifespan and for which networks is still unclear. A major task for current research is a successful integration of these methods to understand how development and learning shape the neural networks underlying achievements in literacy, numeracy, and attention. This paper seeks to foster further integration by reviewing the current state of knowledge relating brain changes to behavior and indicating possible future directions.