Group-based instrumental musical training to enhance resilience among school-aged children from low-income families: A pilot randomised waitlist controlled trial

AIM

To evaluate the acceptability, feasibility and potential effectiveness of a group-based instrumental musical training programme in improving resilience, depressive symptoms, self-esteem and quality of life among school-aged children from low-income families.

DESIGN

Assessor-blinded pilot randomised waitlist controlled trial with process evaluation.

METHODS

This study was conducted in the community from January 2022 to July 2023. Sixty-four children from low-income families (aged 8-12 years) were randomised (1:1) to intervention and waitlist control groups. The intervention group (n = 32) received weekly 1-hour instrumental musical training for 6 months in groups of four to five from professionally qualified musicians at a music centre. The participants in the waitlist control group (n = 32) received the same intervention as the participants in the intervention group after the completion of all outcome assessments. The primary outcome was the children's levels of resilience, measured using the Resilience Scale for Children - 10. The secondary outcomes were depressive symptoms, self-esteem and quality of life. Assessments were conducted at baseline (T0) and immediately post-intervention (T1). An intention-to-treat analysis was performed.

RESULTS

The 64 participants had a mean (SD) age of 9.5 (1.44) years, and 37 (57.8%) were boys. Compared with the waitlist control group, participants in the intervention group showed significantly greater improvements in resilience levels from baseline to T0 (group-by-time interaction coefficient β = 4.41; 95% CI, 1.82-6.99; p = 0.001), depressive symptoms (β = -6.42; 95% CI, -11.12 to -1.71; p = 0.008), self-esteem (β = -2.60; 95% CI, 0.28-4.92; p = 0.028) and quality of life (β = 6.69; 95% CI, 0.18-13.2; p = 0.044).

CONCLUSION

The group-based instrumental musical training programme was feasible and acceptable for school-aged underprivileged children and showed the potential to improve the resilience and quality of life of this vulnerable population.

Improving the education and wellbeing of student parents

Student parents, who make up approximately four million US undergraduates, are highly motivated to succeed in school but often face barriers to educational success due to logistical and financial constraints as well as mental health stressors. This randomized control trial examined the effectiveness of an education program centered in an adult workforce agency that was specifically designed to meet the needs of student parents and their families. Family-centered supportive services included coordinated parent-child schedules and childcare in addition to peer cohorts led by coaches, tuition-free courses, and additional financial assistance. Two hundred seventy-seven parents responded to online survey questions about their education and career, wellbeing, and parenting at baseline and approximately 1 year later (treatment n = 191, control n = 86). The racially and ethnically diverse pool of parents consisted mostly of low-income mothers aged 29 years on average who had a high school diploma or completed a General Educational Development (GED) program. After 1 year, parents in the education program were more likely to obtain at least a certificate or associate degree compared to control parents. These findings suggest that a family-focused approach is key to improving the educational success of student parents.

Exacerbation of household food insecurity among low-income families in Hong Kong during the COVID-19 pandemic

AIM

The economic depression and reduced physical mobility associated with COVID-19 potentially affected the food security status of the poor. This study aimed to assess the possible worsening of perceived food insecurity among low-income families in Hong Kong.

METHODS

Families either receiving government subsidies or living in a subdivided flat referred by local non-governmental organisations were invited to participate in a telephone survey. Food security status before (by recalling) and during the pandemic were assessed using Household Food Insecurity Access Scale. Chi-square analysis and ANOVA were used to test the difference between the percentage of participants who responded affirmatively to survey questions and various categories of food insecurity. Paired t-test was used to examine the reported change in food insecurity score before and during the COVID-19 pandemic. Association between socio-demographic factors and change in food insecurity score was then assessed by multiple linear regression using backward stepwise elimination.

RESULTS

Findings from the 212 households revealed that, for all nine questions concerning food insecurity, there was a significantly higher percentage of affirmative responses during versus before the pandemic. The proportion of food-secure households dropped from 16.5% to 7.1% amidst the pandemic. By contrast, households with severe food insecurity increased from 19.3% to 33.5%. Regression analysis showed that those households who were living in subdivided flats and with high monthly housing expenses, were likely to experience an exacerbation of food insecurity. Meanwhile, households with divorced parents (probably due to consistent social subsidy) and high household incomes, showed resilience toward food insecurity. Concurrently, about one fifth of children in these households had an experience of starvation for a whole day due to financial constraints.

CONCLUSION

The exacerbation of food insecurity among low-income families during the COVID-19 pandemic necessitates timely assessments and the implementation of appropriate measures to prevent them from experiencing physiological harm. These initiatives can be guided by the identified at-risk socio-economic characteristics in the present study.

Day-to-day variation in adolescent food insecurity

This study examined differences in both average and variability in daily adolescent food insecurity, by adolescents' levels of economic disadvantage and race/ethnicity. We used data from a 14-day ecological momentary assessment of 395 adolescents enrolled in public schools in North Carolina. Each evening, adolescents were asked questions about that day's food insecurity. Economically disadvantaged adolescents reported both higher average food insecurity and more day-to-day variability in food insecurity than non-economically disadvantaged adolescents. Controlling for economic disadvantage, Black adolescents also experienced both higher average food insecurity and more variability from day to day than White or Hispanic adolescents. For those receiving Supplemental Nutrition Assistance Program (SNAP) benefits, daily food insecurity was higher in the second half of the month after SNAP transfer than in the beginning of the month. Food insecurity among adolescents is not static but varies from day to day. This daily variation is greater for economically disadvantaged youth.

Obesity Risk Assessment for Spanish-Speaking Immigrant Families with Young Children in the United States: Reliability and Validity with Nutrient Values

The purpose is to examine validity and reliability for an obesity risk assessment tool developed in Spanish for immigrant families with children, 3-5 years old using an 8-week cross-sectional design with data collected over 1 year at Head Start and Special Supplemental Nutrition Program for Women, Infants and Children [WIC]. Parent/child dyads (206) provided a child obesity risk assessment, three child modified 24 h dietary recalls, three child 36+ h activity logs and one parent food behavior checklist. Main outcome measures were convergent validity with nutrients, cup equivalents, and diet quality and three assessments of reliability that included item difficulty index, item discrimination index, and coefficient of variation. Validity was demonstrated for assessment tool, named Niños Sanos. Scales were significantly related to variables in direction hypothesized [p ≤ 0.05]: Healthy Eating Index, fruit/vegetable cup equivalents, folate, dairy cup equivalents, vitamins D, β-carotene, fiber, saturated fat, sugar, time at screen/ sleep/physical activity and parent behaviors. Three measures of reliability were acceptable. The addition of nutrient values as an analytical validation approach adds strength and consistency to previously reported Niños Sanos validation results using children's blood biomarkers and body mass index. This tool can be used by health professionals as an assessment of obesity risk in several capacities: (1) screener for counseling in a clinic, (2) large survey, (3) guide for participant goal setting and tailoring interventions, and (4) evaluation.

Cultural considerations in the assessment of sensitivity in low-income caregivers in Ethiopia

Background

Caregiver sensitivity is associated with positive child outcomes, and improving sensitivity is often the aim of parenting-directed interventions. However, sensitivity was conceptualized in Western cultures, and its application in populations with different backgrounds is still limited.

Objective

This study aimed to foster a contextualized cultural understanding of the meaning and nature of sensitivity by assessing the possibility of evaluating sensitivity in a low-income population living in Ethiopia and describing the nature of (in)sensitive parenting. Moreover, the associations between sensitivity and discipline, the quality of the environment, and individual characteristics were explored.

Methods

Parental sensitivity was coded on naturalistic video-recorded observations of free interactions between 25 female primary caregivers and their children. Caregivers completed questionnaires on discipline strategies and the level of satisfaction with the environment (access to basic needs, quality of house condition, community and family support, quality of learning opportunities, and working conditions).

Results

The assessment of sensitivity in this population was possible, with caregivers showing the full range of sensitivity levels. A description of manifestations of sensitivity in this population is provided. A K-means cluster analysis evidenced that high sensitivity was associated with high satisfaction regarding housing conditions and family environment. No association between sensitivity and discipline emerged.

Conclusion

The findings show the feasibility of assessing sensitivity in this sample. The descriptions of observed behaviors contribute to understanding culturally specific aspects of sensitivity to consider when assessing sensitivity in similar populations. The study provides considerations and guidelines to inform the structure of culturally-based interventions to promote sensitive parenting in similar cultural and socioeconomic situations.

The Impact of a Health Empowerment Program on Self-Care Enablement and Mental Health among Low-Income Families: Evidence from a 5 Year Cohort Study in Hong Kong

Health empowerment can be an effective way to reduce health inequities. This prospective cohort study evaluated the 5 year impact of a health empowerment program (HEP) on health outcomes among adults from low-income families. The Patient Enablement Instrument version 2 (PEI-2), Depression, Anxiety and Stress Scale 21 (DASS-21), and 12 item Short-Form Health Survey version 2 (SF-12v2) were administered at baseline and follow-up for both intervention and comparison groups. A total of 289 participants (n = 162 for intervention group, n = 127 for comparison group) were included in the analysis. Most of the participants were female (72.32%), and aged from 26 to 66 years old (M = 41.63, SD = 6.91). Linear regressions weighted by inverse probability weighting using the propensity score showed that, after follow-up of 5 years, the intervention group demonstrated significantly greater increases in all items and total scores for the PEI-2 (all B > 0.59, p < 0.001), greater decreases in the DASS depression score (B = -1.98 p = 0.001), and greater increases in the Mental Component Summary score of the SF-12v2 (B = 2.99, p = 0.027) than the comparison group. The HEP may be an effective intervention enabling adults from low-income families to manage their health-related issues and improve their mental health, as evidenced by our study.

Low-Income Families' Direct Participation in Food-Systems Innovation to Promote Healthy Food Behaviors

Low-income families, especially those who reside in food deserts, face significant systemic barriers regarding their ability to access affordable and nutritious food. The food behaviors exhibited by low-income families are a reflection of the shortcomings of the built environment and conventional food system. Policy and public-health initiatives to improve food security have, thus far, failed to deliver interventions that simultaneously address multiple pillars of food security. Centering the voices of the marginalized and their place-based knowledge may result in the development of food-access solutions that are a much better fit for the population that they intend to serve. Community-based participatory research has emerged as a solution to better meet the needs of communities in food-systems innovation, but little is known about the extent to which direct participation improves nutritional outcomes. The purpose of this research is to answer the following question: how can food-access solutions authentically engage marginalized community members in food-system innovation, and if participation is related to changes in their food behaviors, how is it related? This action research project leveraged a mixed-methods approach to analyze nutritional outcomes and define the nature of participation for 25 low-income families who reside in a food desert. Our findings suggest that nutritional outcomes improve when major barriers to healthy food consumption are addressed, for example, time, education, and transportation. Furthermore, participation in social innovations can be characterized by the nature of involvement as either a producer or consumer, actively or inactively involved. We conclude that when marginalized communities are at the center of food-systems innovation, individuals self-select their level of participation, and when primary barriers are addressed, deeper participation in food-systems innovation is associated with positive changes in healthy food behaviors.

Peer Relationship Profiles among Early Adolescents from Low-Income Families: The Unique and Combined Effects of Attachment to Mothers and Conscientiousness

Using research data gathered from multiple sources, the current study explored positive aspects of peer relationship profiles (indexed by peer-nominated acceptance and self-reported friendships) in a person-centered approach among early adolescents from low-income families. Moreover, this study investigated the unique and combined associations of adolescents' attachment to mothers and parent-rated conscientiousness with emerging peer relationship profiles. A total of 295 early adolescents (42.7% girls; M_age = 10.94, SD = 0.80) were involved in this study. Latent profile analysis identified three empirically derived peer relationship profiles: "isolated" (14.6%), "socially competent" (16.3%), and "average" (69.1%). Moderation analyses further showed that adolescents with secure attachment to mothers tend to have group memberships in socially competent and average profiles than the isolated profile. Such an association pattern was more heightened for those with higher conscientiousness (versus lower conscientiousness).

A Pilot Randomized Trial of an Obesity Prevention Program for High-Risk Infants in Primary Care

OBJECTIVE

Rapid infant weight gain is associated with later obesity. Novel interventions to prevent rapid infant weight gain that are accessible to infants and families are needed, especially for those at the highest risk. Our aims were to examine: (a) feasibility and acceptability of a responsive parenting intervention delivered via Integrated Behavioral Health (IBH) in pediatric primary care and (b) preliminary effects on infant weight gain from birth to 6 (post-treatment) and 9 (follow-up) months.

METHODS

A parallel design, proof-of-concept randomized control trial was conducted with 65 mother-infant dyads (32 randomized to intervention, 33 randomized an IBH attention control focused on promoting healthy mental health), in which the majority identify as Black (80%) and low income (91% receiving Medicaid). Participants and assessors were masked to treatment condition. Outcomes included feasibility (enrollment), acceptability (retention and adherence), and conditional weight gain (CWG), an indicator of rapid weight gain.

RESULTS

The intervention was feasible (90% of eligible families enrolled) and acceptable (89% of families retained), with 81% receiving ≥3 of 4 treatment sessions. A medium effect was found on CWG (d = -0.54 post-treatment, d = -0.57 follow-up), with the infants in the treatment group showing significantly lower CWG (mean = -0.27, 95% CI, -0.63, 0.09) compared to the control group (mean = 0.29, 95% CI, -0.17, 0.76) at 9 months (p = .04).

CONCLUSIONS

This study demonstrates the feasibility of implementing a responsive parenting obesity prevention intervention within primary care. Delivery in pediatric primary care is advantageous for implementation and reaching at-risk populations. The preliminary effects on CWG are promising and support testing in a larger trial.

The health and educational impact of removing financial constraints for school sport

Financial barriers often restrict sport participation among children from low-income families. Schools are thought to offer equitable access to programming, including school sport participation. However, pay-to-play school sport models can inhibit participation among students from low-income households. Recognizing the potential benefits of school sport and realizing the financial barriers to participation, the purpose of this study was to understand the extent to which school sport promotes educational experiences and holistic well-being of Canadian youth from low-income families. A case study was conducted with stakeholders who were supported by funding from a non-profit organization to help cover the costs of school sport registration fees. Data were collected from in-depth interviews with low-income students and their parents, teacher-coaches and school administrators. Three overarching themes were representative of the experiences of school sport participation among low-income students: (1) healthy student-athletes, (2) developing student-athletes in school, for life, and (3) supporting student-athletes as a community. The participants perceived that school sport participation offered holistic health benefits, and developed skills and behaviours that support positive educational experiences and foster life skills. Further, our results highlighted the importance of the school community in supporting low-income students to participate in school sport teams and the need to reframe school sport to better support low-income families.

A randomized controlled trial of technology-enhanced behavioral parent training: sustained parent skill use and child outcomes at follow-up

BACKGROUND

Early-onset (3-8 years old) disruptive behavior disorders (DBDs) have been linked to a range of psychosocial sequelae in adolescence and beyond, including delinquency, depression, and substance use. Given that low-income families are overrepresented in statistics on early-onset DBDs, prevention and early-intervention targeting this population is a public health imperative. The efficacy of Behavioral Parent Training (BPT) programs such as Helping the Noncompliant Child (HNC) has been called robust; however, given the additional societal and structural barriers faced by low-income families, family engagement and retention barriers can cause effects to wane with time. This study extends preliminary work by examining the potential for a Technology-Enhanced HNC (TE-HNC) program to improve and sustain parent skill proficiency and child outcomes among low-income families.

METHODS

A randomized controlled trial with two parallel arms was the design for this study. A total of 101 children (3-8-years-old) with clinically significant problem behaviors from low-income households were randomized to HNC (n = 54) or TE-HNC (n = 47). Participants were assessed at pre-treatment, post-treatment, 3-month, and 6-month follow-ups. Primary outcomes were parent-reported and observed child behavior problems. Secondary outcomes included observed parenting skills use (ClinicalTrials.gov Identifier: NCT02191956).

RESULTS

Primary analyses used latent curve modeling to examine treatment differences in the trajectory of change during treatment, maintenance of treatment gains, and levels of outcomes at the 6-month follow-up. Both programs yielded improvements in parenting skills and child problems at post-treatment. However, TE-HNC families evidenced greater maintenance of parent-reported and observed child behavior and observed positive parenting skills at the 6-month follow-up.

CONCLUSIONS

Our findings contribute to an ongoing line of work suggesting that technology-enhanced treatment models hold promise for increasing markers of engagement in BPT and sustaining long-term outcomes among low-income families.

Effect of daily school and care disruptions during the COVID-19 pandemic on child behavior problems

The COVID-19 pandemic profoundly affected American families and children, including through the closure or change in the nature of their care and school settings. As the pandemic has persisted, many children remain in remote schooling and those attending in-person childcare or school have contended with unpredictable closures. This study investigated the frequency and consequences of disruptions to children's childcare and school arrangements during Fall 2020. The sample is parents who were hourly service-sector workers prior to the pandemic, had a young child between the ages of 3 and 8, and were at least partially responsible for their children's school and/or care in Fall 2020 (N = 676); half of the sample were non-Hispanic Black, 22% were Hispanic, and 18% are non-Hispanic White. Parents were asked to complete 30 days of daily surveys about whether their care and school arrangements went smoothly and as predicted that day, about their mood, parenting behaviors, and children's behavior. Results showed that daily disruptions to care and school were common, with families reporting a disruption on 24% of days. Families with children in exclusively remote schooling experienced more frequent disruption than families with children in in-person care or school. For all families, care or school disruptions were related to worse child behavior, more negative parental mood, and increased likelihood of losing temper and punishment. Within-family mediation suggests that parents' difficulties supporting children's learning, and to a lesser degree their mood and parenting behaviors, partially mediate effects of disruptions on child behavior. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Vocabulary production in toddlers from low-income immigrant families: evidence from children exposed to Romanian-Italian and Nigerian English-Italian

The relationship between first and second language in early vocabulary acquisition in bilingual children is still debated in the literature. This study compared the expressive vocabulary of 39 equivalently low-SES two-year-old bilingual children from immigrant families with different heritage languages (Romanian vs. Nigerian English) and the same majority language (Italian). Vocabulary size, vocabulary composition and translation equivalents (TEs) were assessed using the Italian/L1 versions of the CDI. Higher vocabulary in Italian than in the heritage language emerged in both groups. Moreover, Romanian-Italian-speaking children produced higher proportions of TEs than Nigerian English-Italian-speaking children, suggesting that L1-L2 phonological similarity facilitates the acquisition of cross-linguistic synonyms.

Low-Income Turkish Mothers' Conceptions and Experiences of Family Life

The current qualitative study explores women's conceptions of the normative family and their day-to-day family lives. To that aim, we conducted five focus group interviews in two low-income neighborhoods of Istanbul. The sample included 43 women (42 biological mothers and a grandmother) who had at least one child between ages 3 and 8 in their care. Participants were 35.64 years old on average (SD = 4.74) and were all married. Women had approximately two children (SD = 0.72) whose mean age was 7.92 years old (SD = 3.11). Each focus group was semi-structured, lasted for 1-1.5 h, and included 5-12 participants. Thematic analysis of the focus group interview data, moderator memos, and observer's notes revealed five defining features of healthy family functioning: cohesion, healthy child, parenting, conflict, control, and family organization. Overall, women prioritized motherhood over their other social identities and idealized the happy family, which contradicted their actual lived experiences in the family system. We discuss how women's depictions of all family processes revolved around cultural constructs of gender, socio-economic status, and independence/interdependence. The findings of this study shed light on future interventions for low-income women and their families in Turkey.

Screen time use impacts low-income preschool children's sleep quality, tiredness, and ability to fall asleep

BACKGROUND

Sleep is increasingly recognized as a vital part of health. Screen time has been linked to sleep quality in children. The purpose of this study was to analyze associations between screen time and sleep characteristics among low-income preschoolers.

METHODS

A total of 1,700 preschool-aged children participated in this study at 50 federally and state-funded preschool centers in Michigan. Baseline measurement for an ongoing longitudinal intervention trial was obtained for cross-sectional use. At baseline, parents reported the number of hours their child spent engaging in screen time on a typical week day and weekend. An aggregate measure of total screen time was created. Parents reported on the quality of their child's sleep, how often they were tired during the day, and whether they had difficulty falling asleep. A mixed model linear regression was created to analyze data.

RESULTS

Controlling for child's age, race, and parental income, children who engaged in more screen time were significantly more likely to have more trouble falling or staying asleep, be tired during the day, and had worse quality of sleep (P values = .004, .006 and .001, respectively). Spearman correlations of screen time, sleep variables and demographics show parents of Black children reported significantly higher weekly screen time than parents of non-Black children (r = 0.23, P < .001) and that tiredness was associated with Black race (r = 0.15, P < .001), Hispanic/Latino ethnicity (r = -0.14, P < .001), and parental education (r = 0.06, P = .016).

CONCLUSION

This report confirms prior associations between screen time and sleep reported in other pediatric populations. Further research is needed to confirm these results in other populations using more rigorous measures of screen time, sleep, and physical activity, as well as longitudinal assessments. Despite these limitations, findings suggest that interventions to help parents limit children's screen time and impact their sleep health merit investigation.

Sustained Benefits of a Preschool Home Visiting Program: Child Outcomes in Fifth Grade

This study evaluated the sustained effects of the Research-based Developmentally Informed Parent program (REDI-P) at fifth grade, six years after intervention. Participants were 200 prekindergarten children attending Head Start (55% White, 26% Black, 19% Latinx, 56% male, mean age of 4.45 years at study initiation) and their primary caregivers, who were randomly assigned to a control group or a 16-session home-visiting intervention that bridged the preschool and kindergarten years. In addition, the study explored moderation of sustained effects by parenting risks (e.g., less than high-school education, single-parent status, parental depression, and low parent-child warmth). Growth curves over the course of the elementary years examined outcomes in three domains: child academic performance, social-emotional adjustment, and parent-child functioning. At fifth grade, significant main effects for intervention were sustained in the domains of academic performance (e.g., reading skills, academic motivation, and learning engagement) and parent-child functioning (e.g., academic expectations and parenting stress). Significant moderation by parenting risk emerged on measures of social-emotional adjustment (e.g., social competence and student-teacher relationships); parenting risk also amplified effects on some measures of academic performance and parent-child functioning, with larger effects for children from families experiencing fewer risks. Implications are discussed for the design of preschool home visiting programs seeking to enhance the school success and social-emotional well-being of children living in poverty.

Work Schedule Unpredictability: Daily Occurrence and Effects on Working Parents' Well-Being

OBJECTIVE

To investigate the pervasiveness and frequency of work schedule unpredictability among workers in low-wage hourly jobs and the effects of work schedule unpredictability on worker and family well-being.

BACKGROUND

Family science has long considered the ways in which parents' experiences in the workplace can affect families. Although unpredictability in work schedules has increased over time, especially for low-wage workers, the effects of schedule unpredictability on worker and family well-being have been understudied.

METHOD

Ninety-two workers with children aged 2-7, recruited using a new venue-time sampling technique, were asked to complete once-a-day surveys for 30 consecutive days (N = 2,221 person-days for analysis). Descriptive analyses and regression models with family fixed effects were utilized.

RESULTS

Work schedule unpredictability was common in the context of families' lives: over the 30 days, parents experienced an unanticipated work schedule change on 13.3% of days, and 87% of parents experienced at least one unanticipated work schedule change. Within families, unpredictable work schedule changes on a given day were associated with worse outcomes that day for parents, including increased negative mood and decreased perceived sleep quality.

CONCLUSION

Work schedule unpredictability is ubiquitous in the lives of low-wage hourly workers and is negatively related to working parents' well-being.

IMPLICATIONS

These results provide evidence that unscheduled and canceled shifts typical of low-wage service jobs may harm parents' well-being, which could ultimately affect their children's development and well-being.

Medication Adherence and Influencing Factors Among Patients With Severe Mental Disorders in Low-Income Families During COVID-19 Outbreak

BACKGROUND

The COVID-19 has spread across the globe in a short time and affected people's life, especially patients with severe mental disorders. Poor adherence to antipsychotics was usually associated with an increasing risk of relapse. This study investigated medication adherence status among patients with severe mental disorders in low-income families during COVID-19 outbreak and the influencing factors.

METHODS

To select patients with severe mental disorders in low-income families in central China's Henan Province, we used multi-stage stratified random sampling method. Trained interviewers and psychiatrists collected questionnaire responses from the patients through face-to-face interviews or video interviews. Logistic regression models were used to examine factors that influence the status of medication adherence.

RESULTS

A total of 24,763 valid questionnaires were collected between March 10, 2020, and March 31, 2020. The regular medication rate of patients with severe mental disorders in low-income families during the COVID-19 outbreak was 51.46%. Twelve factors were found to influence medication adherence of investigated individuals. Positive factors for regular medication were younger age, higher education level of patients and their guardians, higher medical expenditure, higher level of self-care ability, having subsidies for care and supervision, having disability certificate and personal care, etc.

CONCLUSIONS

The COVID-19 outbreak affected the medication adherence among patients with severe mental disorders in low-income families. The influencing factors are complicated and diverse, including psychological effects, traffic impact, and economy, etc. The government should pay more efforts on social assistance programs and flexibly deal with difficulties during public health emergencies like the COVID-19.

Obesity Risk Assessment Tool for Low-Income Spanish Speaking Immigrant Parents with Young Children: Validity with BMI and Biomarkers of Obesity

Children of Hispanic origin bear a high risk of obesity. Child weight gain trajectories are influenced by the family environment, including parent feeding practices. Excessive body fat can result in unhealthful metabolic and lipid profiles and increased risk of metabolic diseases. The objective was to estimate criterion validity of an obesity risk assessment tool targeting Spanish-speaking families of Mexican origin using anthropometric measures and blood values of their young children. A cross-sectional study design with five data collection sessions was conducted over an eight-week period and involved 206 parent/child dyads recruited at Head Start and the Special Supplemental Nutrition Program for Women, Infants and Children in Northern California. Main outcome measures were criterion validity of Niños Sanos, a pediatric obesity risk assessment tool, using anthropometric measures and blood biomarkers. Niños Sanos scores were inversely related to child BMI-for-age percentiles (p = 0.02), waist-for-height ratios (p = 0.05) and inversely related to blood biomarkers for the metabolic index (p = 0.03) and lipid index (p = 0.05) and positively related to anti-inflammatory index (p = 0.047). Overall, children with higher Niños Sanos scores had more healthful lipid, metabolic and inflammatory profiles, as well as lower BMI-for-age percentiles and waist-to height ratios, providing evidence for the criterion validity of the tool. Niños Sanos can be used by child obesity researchers, by counselors and medical professionals during clinic visits as a screening tool and by educators as a tool to set goals for behavior change.

Exposure to Environmental Toxicants and Early Language Development for Children Reared in Low-Income Households

Considerable evidence has highlighted the heightened susceptibility of developmental delay in children from low-income homes; consequently, this study explored whether environmental toxicant exposure may be a contributing factor to disruption in language and cognitive development for children reared in poverty. Using a sample of 190 low-income mothers and their young children, mothers completed questionnaires on toxicant exposure in the home environment. Exposure to toxicants, especially pesticides, was reported by about 20% of mothers at or around pregnancy, and 30% when their children were between 1 and 2 years of age. Toxicant exposure was significantly associated with lags in language and cognition even when controlling for socioeconomic factors. Study findings highlight the importance of the American Academy of Pediatrics' policy statements arguing for pediatricians to take a strong anticipatory guidance role in counseling parents to limit chemical exposure in the home and engage in safe storage practices.

'He supported me 100%': Mexican-immigrant fathers, daughters, and adolescent sexual health

Objective: First and second generation Mexican-origin adolescents in the U.S. face social and economic disadvantage and sexual health disparities. Although fathers can support child and adolescent development, the literature has portrayed Mexican-origin immigrant fathers as emotionally distant and sexist. This study aims to treat migration as a social determinant of health to examine father-daughter relationships and adolescent sexual health in Mexican-origin immigrant families.Methods: Integrating qualitative data from life history interviews with 21 Mexican-origin young women in immigrant families with quantitative data on first and second generation Mexican-origin young women in the National Longitudinal Study of Adolescent to Adult Health, this study describes father-daughter relationships, examines the association between father-daughter relationships and daughters' early sexual initiation, and considers the impact of migration on the father-daughter relationship and sexual health among Mexican-origin young women.Results: Qualitative data identify four types of father-daughter relationships: 'good,' hostile, distant, and conflicted. Supporting the qualitative patterns, quantitative data find that positive or 'good' father-daughter relationship quality is significantly associated with reduced risk of early sexual initiation. Importantly, father-daughter separation across borders and economic inequality facing immigrant families is associated with hostile or distant father-daughter relationship quality and increased risk of early sexual initiation.Conclusions: Reports of good father-daughter relationships are common and may protect against early sexual initiation in Mexican-origin immigrant families. Policies that keep families together and reduce economic inequality among immigrants may also reduce sexual health disparities among immigrant adolescents.

Accessing Physical Activity and Health Disparities among Underserved Hispanic Children: The Role of Actual and Perceived Motor Competence

Promoting physical activity (PA) and eliminating health disparities among underserved minority children is a public health priority. The main purpose of this study was to examine the relationship of actual motor competence (a set of object control skills) and perceived motor competence with PA participation and health-related quality of life (HRQoL) among underserved Hispanic children who were born in the U.S. Guided by Stodden et al.’s conceptual model, we tested the direct and indirect effects (mediational model) of actual motor competence on health-related outcomes (PA and HRQoL) through perceived motor competence. Participants were 215 underserved Hispanic children (M_age = 10.55 years, SD = 0.53 [age range 10–12]; 51.6% boys), recruited from four elementary schools in the southwestern U.S., who completed validated questionnaires assessing their perceived motor competence, PA, and HRQoL. Their actual motor skills were assessed using PE Metrics^TM. After examining the associations among the variables, we tested the hypothesized model using structural equation modeling (SEM; AMOS 25). The hypothesized model indicated a good fit (χ²/df = 38.427/24 = 1.60 < 5; non-normed fit index (NFI) = 0.93; comparative fit index (CFI) = 0.968; root mean square error of approximation (RMSEA) = 0.053 [0.016, 0.083]). The effect of actual motor competence on PA and HRQoL was fully mediated by perceived motor competence. The findings demonstrated the mediating role of perceived motor competence between actual motor competence and health-related outcomes (PA and HRQoL) among underserved Hispanic children. The results highlight that actual motor competence significantly predicted underserved Hispanic children’ perceived motor competence, which in turn positively predicted their PA and HRQoL. These findings have significant practical implications for future intervention strategies of randomized clinical trials in schools aimed at promoting PA and HRQoL and eliminating health disparities among underserved Hispanic children.

Breastfeeding Behaviors and Maternal Interaction Quality in a Low-Income, Ethnic Minority Population

OBJECTIVE

To examine the associations between breastfeeding intensity and underexplored features of maternal-child interaction quality over and above the influence of breastfeeding initiation.

METHODS

The current study leveraged an on-going, multisite randomized controlled trial of a tiered parenting program for 462 Medicaid-eligible mothers and their infants in the United States. We examined whether breastfeeding intensity and exclusivity was associated with observed maternal sensitivity, intrusiveness, and detachment, as well as self-reported maternal verbal responsiveness, 6 months infant age. Analyses controlled for breastfeeding initiation, demographics, and early parenting experiences.

RESULTS

Higher intensity breastfeeding at 6 months was significantly related to higher maternal sensitivity (β = 0.12, p = 0.004) and lower maternal intrusiveness (β = -0.10, p = 0.045). There was no significant association between breastfeeding intensity at 6 months and detachment (β = -0.02, no significant [ns]) or self-reported verbal responsiveness (β = 0.11, ns). Results were the same when intensity was measured as a dichotomous indicator for exclusive breastfeeding. Effect sizes were small-to-moderate, ranging from Cohen's d = 0.26 to 0.31. Associations did not vary by site, race/ethnicity, infant difficultness, or household poverty.

CONCLUSION

The finding that breastfeeding intensity was significantly and independently associated with maternal sensitivity and intrusiveness is novel in the literature on low-income families from the United States. These findings have implications for breastfeeding promotion strategies and indicate that future research should explore synergistic or spillover effects of interventions aimed at maternal-child interaction quality into the infant feeding domain, particularly in the primary care setting.

Premarital parenthood and newlyweds' marital trajectories

An increasing number of couples in the United States are entering their first marriage having already had a child together, raising important questions about whether and how these couples' marriages differ from newlywed couples who enter marriage without children. The current study used 5 waves of data collected over the first 4.5 years of marriage from a sample of ethnically diverse, first-married newlywed couples living with low incomes to examine the effects of premarital parenthood on couples' self-reported satisfaction, observed communication, and marital dissolution over time. Among couples who entered marriage with a shared biological child (premarital parents), satisfaction levels were lower and communication was less effective, less positive, and more negative than couples entering marriage without children. Rates of change in marital functioning did not differ between groups, but the rate of marital dissolution was twice as high among premarital parents (19.1%) relative to couples who were not parents at the start of marriage (9.5%). These between-groups differences remained robust after controlling for several demographic differences (race, age, education, household income, work status, relationship length, premarital cohabitation), and initial differences in communication did not account for between-groups differences in marital satisfaction or dissolution. Together, these findings indicate that newlywed marriage unfolds in similar ways for low-income couples with and without children at the start of marriage, but couples raising children at the time of marriage have greater vulnerability to marital distress and dissolution. Further research is needed to characterize this risk and how interventions can offset it. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Do Negative Emotional States Play a Role in the Association Between Intimate Partner Violence and Poor Health-Related Quality of Life in Chinese Women From Low-Income Families?

A cross-sectional analysis of a dataset of 156 participants in a health assessment program explored whether negative emotional states mediated the association between intimate partner violence (IPV) and health-related quality of life (HRQoL). Compared with IPV screen-negative participants, those who screened positive had significantly lower HRQoL and significantly higher levels of depression, anxiety, and stress. The inverse associations between the presence of IPV and HRQoL were found to be mediated by depression, anxiety, and stress. Therefore, interventions to alleviate negative emotions in women suffering from IPV have the potential to be useful in improving their HRQoL.

Does public housing reduce housing cost burden among low-income families with children?

About half of all renter households and over three-quarters of very low-income households in the United States experience a housing cost burden, with higher rates among families with children. Public housing may be an important tool for reducing families' housing cost burdens. The current study uses nearly four decades of data from the Panel Study of Income Dynamics and its Assisted Housing Database to explore the relationship between public housing and housing cost burden among children in low-income families. Results from fixed effects models suggest that public housing is associated with a greatly reduced risk of experiencing housing cost burden when housing assistance receipt is measured a year before housing cost burden. These findings highlight the importance of public housing for reducing low-income families' housing cost burdens.

Prenatal use of cleaning and scented products and its association with childhood asthma, asthma symptoms, and mental health and developmental comorbidities

INTRODUCTION

Occupational use of cleaning chemicals has been related to asthma in adults. However, little information is available on the effect of non-occupational use of cleaning products during pregnancy on childhood asthma. This study examines the association between prenatal exposure to cleaning and scented products with childhood asthma, asthma symptoms, and mental and developmental comorbidities among low-income families in Karachi, Pakistan.

METHODS

Four hundred children from the Koohi Goth Women's Hospital were included in the study. Parents' or guardians reported current asthma, asthma-related symptoms, mental health problems, and behavioral problems among the children. Multivariable logistic regression analysis was used to examine the association between the use of cleaning and scented products during pregnancy and seven different outcome variables.

RESULTS

The odds of nocturnal cough were significantly elevated among children whose mothers reported the use of cleaning products (OR: 2.23, 95% CI: 1.15-4.31) or scented products (OR: 2.15, 95% CI: 1.22-3.77) during pregnancy. Mental health comorbidities were threefold elevated (OR: 3.05, 95% CI: 1.74-5.35) among children whose mothers reported using scented products during pregnancy. There was no statistically significant association of the prenatal use of cleaning or scented products with current asthma status or nocturnal symptoms of wheezing, shortness of breath, and chest tightness among children.

CONCLUSIONS

The study results indicate prenatal exposure to cleaning and scented products is associated with nocturnal cough among children. The study also suggests an association between prenatal use of scented products and mental health comorbidities among children.

Informal Networks of Low-Income Mothers: Support, Burden, and Change

OBJECTIVE

The authors examined the support and burden of low-income, urban mothers' informal networks.

BACKGROUND

Living or growing up in poverty strongly predicts barriers and instability across several life domains for mothers and their children. Informal networks can play a critical role in promoting maternal and child well-being particularly in the midst of poverty. Understanding informal support and the reciprocal burden it may create is especially relevant for low-income families living with a reduced public safety net in the post-welfare reform era. Therefore, study aims were to measure support and burden among low-income mothers and determine if support and burden change over time.

METHOD

Data were from the Welfare, Children, Families (WCF) project, a longitudinal study of 2,400 low-income, caregivers of children and adolescents living in Boston, Chicago, or San Antonio (http://web.jhu.edu/threecitystudy/index.html)). We applied latent class analyses to support and burden indicators in four domains-emotional, favor, child care, and financial.

RESULTS

Results supported four profiles of informal networks - healthy, unhealthy, burden only, and support only. Although most mothers had healthy informal networks, approximately one-third experienced no support or support imbalance which related to network changes at later time points. Demographic characteristics largely were not predictive of support profile or profile change.

CONCLUSION

Although many mothers had healthy support and burden, the most vulnerable did not have consistently healthy informal networks. The identification of a sizable minority of low-income mothers who cannot consistently rely on informal support is significant in light of diminished formal supports available to children and families.

Reducing Preschool Behavior Problems in an Urban Mental Health Clinic: A Pragmatic, Non-Inferiority Trial

OBJECTIVE

This pragmatic, randomized, non-inferiority trial compared the effectiveness and cost of group-based parent management training with mastery-based individual coaching parent management training in a low-income, predominantly African American sample.

METHOD

Parents seeking treatment for their 2- to 5-year-old children's behavior problems in an urban fee-for-service child mental health clinic were randomized to the Chicago Parent Program (CPP; n = 81) or Parent-Child Interaction Therapy (PCIT; n = 80). Consent followed clinic intake and diagnostic assessment and parent management training was delivered by clinicians employed at the clinic. Primary outcome measures were externalizing child behavior problems, assessed at baseline and postintervention follow-up, using the Child Behavior Checklist (CBCL) and average per-participant treatment cost.

RESULTS

Data from 158 parents were analyzed. Most were mothers (75.9%), African American (70.3%), and economically disadvantaged (98.7% Medicaid insured). Of children, 58.2% were boys, and mean age was 3.6 years (SD 1.03). Based on CBCL scores, behavior problems improved in the 2 conditions (Cohen d = 0.57 for CPP and 0.50 for PCIT). CPP was not inferior to PCIT (90% CI -1.58 to 4.22) at follow-up, even after controlling for differences in treatment length (90% CI -1.63 to 4.87). Average per-participant treatment cost was higher for PCIT (mean $2,151) than for CPP (mean $1,413, 95% CI -1,304 to -170).

CONCLUSION

For parents of young children living in urban poverty, CPP is not inferior to PCIT for decreasing child behavior problems. CPP requires less time to complete and costs a third less than PCIT.

CLINICAL TRIAL REGISTRATION INFORMATION

Early Parenting Intervention Comparison (EPIC); https://clinicaltrials.gov/; NCT01517867.

Parenting and toddler self-regulation in low-income families: What does sleep have to do with it?

Toddlerhood is a sensitive period in the development of self-regulation, a set of adaptive skills that are fundamental to mental health and partly shaped by parenting. Healthy sleep is known to be critical for self-regulation; yet, the degree to which child sleep alters interactive child-parent processes remains understudied. This study examines associations between observed parenting and toddler self-regulation, with toddler sleep as a moderator of this association. Toddlers in low-income families (N = 171) and their mothers were videotaped during free play and a self-regulation challenge task; videos were coded for mothers' behavior and affect (free play) and toddlers' self-regulation (challenge task). Mothers reported their child's nighttime sleep duration via questionnaire. Results revealed significant Sleep × Maternal Negative Affect and Sleep × Maternal Negative Control interactions. Children who did not experience negative parenting had good self-regulation regardless of their nighttime sleep duration. For children who did experience negative parenting, self-regulation was intact among those who obtained more nighttime sleep, but significantly poorer among children who were getting less nighttime sleep. Thus, among children who were reported to obtain less nighttime sleep, there were more robust associations between negative parenting and poorer self-regulation than among toddlers who were reported to obtain more sleep.

Adolescents from low-income families in Hong Kong and unhealthy eating behaviours: Implications for health and social care practitioners

The development of dietary preferences of adolescents involves a complex interplay of individual behaviours and environmental factors. Interpersonal factors-such as peer influences and unpleasant school experiences-and institutional factors-such as school rules and policies-are closely associated with unhealthy eating of adolescents. Family support and guidance are also crucial in influencing adolescents' eating habits. However, the low social status, low educational levels, and low household incomes of disadvantaged parents can markedly prevent their children from establishing healthy eating habits. Therefore, adolescents from low-income families are more likely to engage in unhealthy dietary behaviours and hence to be more susceptible to diet-related health problems. However, few studies have addressed the difficulties associated with inculcating healthy eating habits among adolescents from low-income families. Therefore, to investigate the barriers to adopting healthy eating habits, this study adopted a qualitative research approach and conducted five focus-group semistructured interviews with 30 junior- and senior-form students of a secondary school in Hong Kong, all of whom were from low-income families. The results revealed skipping meals because of poverty, following irregular meal patterns on school holidays, receiving poor guidance from family and peers, perceiving healthy eating as expensive and unappealing, and geographical inaccessibility to healthy food all prevented these students from healthy eating. These mutually reinforcing factors were interlocking with the economic strain that was experienced by the participants and their families. In particular, the stereotype of "healthful food is expensive" was strong. Therefore, we suggest students from low-income families should be enabled to understand that healthy eating is not necessarily expensive. The participants' stereotypes about healthy food was handed down by their parents. Such stereotypes, together with the low health literacy, influence the food preparation habits of the parents. Therefore, parents should be made to aware that healthful food can also be affordable.

Taking Care of Mine: Can Child Support Become a Family-Building Institution?

U.S. children are more likely to live apart from a biological parent than at any time in history. Although the Child Support Enforcement system has tremendous reach, its policies have not kept pace with significant economic, demographic, and cultural changes. Narrative analysis of in-depth interviews with 429 low-income noncustodial fathers suggests that the system faces a crisis of legitimacy. Visualization of language used to describe all forms child support show that the formal system is considered punitive and to lead to a loss of power and autonomy. Further, it is not associated with coparenting or the father-child bond-themes closely associated with informal and in-kind support. Rather than stoking men's identities as providers, the system becomes "just another bill to pay." Orders must be sustainable, all fathers should have coparenting agreements, and alternative forms of support should count toward fathers' obligations. Recovery of government welfare costs should be eliminated.

Identifying Positive Adaptive Pathways in Low-Income Families in Singapore: Protocol for Sequential, Longitudinal Mixed-Methods Design

Background

This study aims to examine the adaptive process of children and mothers from multistressed low-income families in Singapore. It aims to bridge the knowledge gap left by existing poverty studies, which are predominately risk focused. Through a sequential longitudinal mixed-methods design, we will differentiate children and mothers who demonstrate varied social, developmental, and mental health trajectories of outcomes. Through utilizing the Latent Growth Curve Model (LGCM), we aim to detect the development and changes of the positive Family Agency and adaptive capacities of these families over time. The construct of Family Agency is underpinned by the theoretical guidance from the Social Relational Theory, which examines child agency, parent agency, relational agency, and the interactions among these members. It is hypothesized that positive Family Agency within low-income families may lead to better outcomes. The key research questions include whether the extent of positive Family Agency mediates the relationship among financial stress, resource utilization, home environment, and parental stress.

Objective

The study elucidates the Family Agency construct through interviews with mother-child dyads. It also aims to understand how financial stress and resources are differentially related to home environment, parent stress, and parent and child outcomes.

Methods

In phase 1, 60 mother-child dyads from families receiving government financial assistance and with children aged between 7 and 12 years will be recruited. In-depth interviews will be conducted separately with mothers and children. On the basis of 120 interviews, a measurement for the construct of Family Agency will be developed and will be pilot tested. In phase 2a, a longitudinal survey will be conducted over 3 time points from 800 mother-child dyads. The 3 waves of survey results will be analyzed by LGCM to identify the trajectories of adaptation pathways of these low-income families. In addition, 10 focus groups with up to 15 participants in each will be conducted to validate the LGCM results.

Results

This project is funded by the Social Science Research Thematic Grant (Singapore). The recruitment of 60 mother-child dyads has been achieved. Data collection will commence once the amendment to the protocol has been approved by the Institutional Review Board. Analysis of phase 1 data will be completed by the end of the first quarter of 2019, and the first set of results is expected to be submitted for publication by the second quarter of 2019. Phase 2 implementation will commence in the second quarter of 2019, and the project end date is in May 2021.

Conclusions

Findings from this study can potentially inform social policy and programs as it refines the understanding of low-income families by distinguishing trajectories of adaptive capacities so that policies and interventions can be targeted in enhancing the adaptive pathways of low-income families with children.

International Registered Report Identifier (IRRID)

PRR1-10.2196/11629

Why some children from poor families do well-an in-depth analysis of positive deviance cases in Singapore

Purpose: Research documents that children from low-income families face higher risks in many areas of their development including academic performance. However, some children from low-income homes excel academically despite their disadvantaged environment. Method: Using Positive Deviance methodology (PD), audio-diary and interview data were collected from ten children who scored at least 70 percentile in school examinations in spite of their financial deprivation.Results: This paper uncovers specific dimensions of agency in these children that stemmed from the relational contexts they had with their mothers. Combining the PD methodology and sensitizing lens from Social Relational Theory, this study provided evidence that PD children are connected agents within their family. It suggests that children's awareness of their family circumstances motivated them to work hard and enabled them to devise creative ways to manage their limited financial resources.Conclusions: The findings challenge dominant discourses on poor children as passive victims and suggest new ways for practitioners to examine the relationship contexts that support children's capacity as agents rather than focusing on individual traits.

The association of prenatal risk factors with childhood asthma

Objective: The purpose of the study was to examine the relationship of maternal complications during pregnancy and prenatal exposures with childhood asthma among low-income families in Karachi, Pakistan. Methods: Parents/guardians of children with and without asthma visiting a charity hospital were enrolled. Information about prenatal and perinatal exposures was collected. Univariable and multiple stepwise logistic regression analysis were conducted to explore the relationship of socio-demographic, maternal complications during pregnancy, access to prenatal care, and exposure to animals and pests while pregnant with childhood asthma. Results: Maternal symptoms of nocturnal cough (adjusted OR [aOR = 2.87, 95% CI = 1.60-5.14) and wheezing (aOR = 5.57, 95% CI = 2.32-13.37) during pregnancy significantly increased the odds of childhood asthma. The family history of asthma or hay fever, also elevated the odds of childhood asthma (adjusted OR [aOR] = 5.86 (3.03-11.34). The odds of asthma among children whose mothers received prenatal care by Dai, an unskilled health worker, were significantly elevated. Lastly, prenatal exposure to rats/mice and contact with goats while pregnant was significantly associated with childhood asthma. Whereas, prenatal exposure to cows/cattle reduces the odds of childhood asthma. Conclusions: This study identified important maternal and prenatal risk factors for childhood asthma, the majority of which are avoidable. Appropriate steps are needed to create awareness about the prenatal risk factors in this population.

Childcare Type and Quality among Subsidy Recipients with and without Special Needs

Low-income children, particularly those with special needs, may have limited access to high quality early care experiences. Child care subsidies are intended to increase families' access to quality care, but little is known about subsidy use by children with special needs. Using a nationally representative sample of 4,000 young children who participated in the Early Childhood Longitudinal Study - Birth Cohort, we examined the types and quality of childcare received by children with and without special needs who came from subsidy eligible families. We also investigated the extent to which subsidy use and child and family sociodemographic characteristics predicted care type and quality among young children with special needs who used childcare subsidies at nine months, two years, and four years. Findings indicated that subsidies increased the use of non-parental care, mainly center-based care, as well as home-based care to a lesser extent among children with special needs relative to peers without special needs and relative to peers with special needs who did not use subsidies. However, use of subsidy did not consistently result in families with children with special needs accessing higher quality care. Sociodemographic characteristics of children, families and their context were differentially predictive of type and quality care. We discuss implications for practice and policy to foster quality early care and education of young children with special needs who are receiving subsidies.

A prospective cohort study to investigate parental stress and child health in low-income Chinese families: protocol paper

INTRODUCTION

Chronic stress has adverse effects on health. Adults and children from low-income families are subject to multiple sources of stress. Existing literature about economic hardship mostly focuses on either adults or children but not both. Moreover, there is limited knowledge on the relationship between parental generalised stress and child health problems. This study aims to explore the bidirectional relationship between parental stress and child health in Chinese low-income families and to identify other modifiable factors influencing this relationship.

METHODS AND ANALYSIS

This prospective cohort study will sample 254 low-income parent-child pairs and follow them up for 24 months with assessments at three time points (baseline, 12 and 24 months) on parental stress, health-related quality of life (HRQOL) and child health and behaviour using both subjective measures and objective physiological parameters. This study will collect data using standardised measures on HRQOL and behaviours of children as well as on HRQOL, mental health and stress levels of parents along with physiological tests of allostatic load and telomere length. The mediating or moderating effect of family harmony, parenting style and neighbourhood conditions will also be assessed. Data will be analysed using latent growth modelling and cross-lagged path analysis modelling to examine the bidirectional effect of parental stress and child health over time. Mediation and moderation analysis will also be conducted to examine the mechanism by which the variables relate.

ETHICS AND DISSEMINATION

This study was approved by the institutional review board of the University of Hong Kong-the Hospital Authority Hong Kong West Cluster, reference no: UW 16-415. The study findings will be disseminated through peer-reviewed publications and international conferences.

TRIAL REGISTRATION NUMBER

NCT03185273; Pre-results.

Understanding the Process of Prioritizing Fruit and Vegetable Purchases in Families With Low Incomes: "A Peach May Not Fill You Up as Much as Hamburger"

Fruits and vegetables (F&V) are an important component of a healthy diet, but few children are meeting the recommended number of servings. Children from families with limited resources may be least likely to meet the recommendation. This study was designed to understand the strategies and priorities of families with low income related to purchasing F&V. We conducted qualitative, in-depth telephone interviews with low-income parents of elementary school-aged children as part of a random sample of parents participating in a telephone survey who agreed to be contacted for an in-depth interview. Interview transcripts were coded based on predetermined codes that were informed by the research questions. F&V were not considered staples by parents and cost was one of the main concerns. Parents equated F&V with fresh F&V. Interventions encouraging F&V purchasing by families with low income need to find new ways to address the issue of cost, including advocating for F&V in all forms (fresh, frozen, canned, and dried).

Disagreement in Parental Reports of Father Involvement

Despite agreement on the value of father involvement in children's lives, research has been limited due to the exclusion of fathers in studies, questionable validity of mothers' reports on father involvement, and simple measures of fathering behavior. Our study extends previous research by comparing reports of father involvement using robust, multidimensional father involvement measures. Data from 113 fathers and 126 mothers reporting on 221 children were used to assess father involvement. Results indicate that fathers reported significantly higher levels of involvement than mothers reported. Findings from hierarchical linear models suggest that race/ethnicity and mothers' reports of positive relationship quality were associated with smaller discrepancies in reports of father involvement, whereas nonmarried partnerships, older children, father residence, and biological status predicted larger discrepancies. Our study demonstrates the importance of obtaining father involvement reports directly from fathers and why father involvement should be assessed as a multidimensional construct to examine fathering behavior.

Teacher-child relationships in the context of poverty: the role of frequent school mobility

Children's relationships with their teachers are critical for classroom-based learning, but children growing up in poverty may be at risk for lower-quality relationships with teachers. Little is known about how changing schools, one poverty-related risk, affects teacher-child relationships. Using growth curve models that control for a host of other poverty-related risks, this study explores the association between children changing schools frequently (defined as three or more school moves) between preschool and third grade and the quality of their relationships with their teachers over these five years in a low-income, ethnic-minority sample. Children who frequently moved schools were reported to be less close to their teachers in third grade and experienced steeper declines in closeness than children who did not change schools frequently. Moreover, the effects of frequent school mobility at third grade were robust to other poverty-related risks, including residential mobility, parental education risk, family income, and single-parent households. Changing schools was unrelated to children's conflict with teachers. We discuss these findings in the context of policies that support students' transitions when changing schools.

Giving Unto Others: Private Financial Transfers and Hardship Among Families with Children

Prior research shows that financial assistance from family and friends is an important source of support for families with children. However, research on financial transfers has largely focused on the recipients of transfers. In this study, using longitudinal data from the Fragile Families and Child Wellbeing Study (n~16,000 person-waves), we examine the association between the provision of financial assistance to family and friends and material hardship. Results from pooled regression and fixed effects models indicate that providing financial transfers is associated with an increased risk of hardship. The most economically disadvantaged groups, single mothers, those in the bottom income tertile, and black mothers, are the most likely to experience hardship after giving a transfer. These findings have important implications for understanding why families may have difficulty meeting basic and essential needs, and how social networks may exacerbate the challenges of escaping poverty and establishing economic self-sufficiency.

Comparison of Fluoride Levels in Tap and Bottled Water and Reported Use of Fluoride Supplementation in a United States-Mexico Border Community

BACKGROUND

Compared to the general United States (U.S.) population, Arizona counties along the U.S.-Mexico border have a higher prevalence of dental caries, which can be reduced with adequate fluoride exposure. Because of concern regarding local tap water quality, fluoride-free bottled water consumption is common in this region, raising concern that families are not receiving adequate fluoride to promote dental health.

OBJECTIVE

To evaluate the levels of fluoride in tap and bottled water as well as the use of fluoride supplements in an Arizona border community.

METHODS

Low-income Latino households (n = 90) who report use of bottled water as their primary source of water intake were recruited. Participants completed a questionnaire about their and their children's dental histories and use of fluoride supplements. Water samples (bottled and tap) were collected from a subset of households (n = 30) for analysis of fluoride.

RESULTS

Fluoride detection levels were significantly greater (p = 0.02, Fisher's exact test) in tap water (average = 0.49 mg/dL) than in bottled water, yet, the majority (22/30) were below the range for optimal dental health (0.7-1.2 mg/L). Concentration of fluoride in the majority (29/30) of bottled water samples was below the quantitative detection limit of 0.4 mg/L. Children were significantly less likely to have dental caries if they received fluoride varnishing treatments (p = 0.01, Fisher's exact test), lived in households that reported using fluoridated mouthwash (p < 0.001, Fisher's exact test), their parents received fluoride education (p = 0.01, Fisher's exact test), and their parents reported visiting a dentist yearly (p < 0.001, Fisher's exact test). Furthermore, none of the participants reported receiving recommendations from health-care providers about fluoride supplementation or variance in content by the type of water consumed.

CONCLUSION

Although fluoride was significantly more likely to be detected in tap than bottled water, neither water source in this border community is likely to provide enough fluoride for optimal dental health. Low-income children in this region may benefit from regular access to fluoride varnishing treatments and/or use of fluoridated mouthwash, interventions that could be tested in future well-designed trials.

They Should Say "I Don't": Norms About Midpregnancy Marriage and Job Loss

This study examined effects of local economic conditions on individuals' attitudes toward midpregnancy marriages using an experimental vignette method. Adults (N = 460) were each shown two vignettes about a hypothetical couple expecting a baby; within each vignette pair, vignettes randomly varied as to whether the couple lived in a community that had recently experienced job losses or had stable employment. Respondents indicated if the couple should and will get married before the baby's birth. Results showed that worse local economic conditions led people to believe that marriage would be less common. Among more socio-economically disadvantaged respondents, if the hypothetical couple lived in a community with job loss, fewer respondents also thought that the couple should marry. In contrast, among more socioeconomically advantaged respondents, slightly more respondents thought that the couple should marry. When economic conditions worsen, low-socioeconomic-status individuals may believe that financial prerequisites for marriage become harder to meet.

Association of Healthy Home Environments and Use of Patient-Centered Medical Homes by Children of Low-Income Families

INTRODUCTION

Medicaid agencies have been promoting the patient-centered medical home (PCMH) model. Most caregivers choose physician practices for their children, and we hypothesized that those following healthier childrearing practices are more likely to seek care in a PCMH.

METHOD

We selected children with public insurance plans (n = 20,801) from the 2011-2012 National Survey of Children's Health. We used generalized ordinal logistic regression with state fixed effects to assess the association between home environments and children's use of PCMHs.

RESULTS

Children living in the healthiest homes were 1.33 times (p = .001) more likely to receive care from the highest level of PCMH. In states with early PCMH implementation, the odds increased to 2.11 times (p = .001).

DISCUSSION

Our results show a significant, sizeable relationship between healthier home environments and the use of PCMH by children from low-income families. They provide implications for assessing the effect of PCMH use on health outcomes and use patterns.

Does longer duration of breastfeeding prevent childhood asthma in low-income families?

OBJECTIVE

The objective of this study was to examine the relationship of breastfeeding duration with childhood asthma among low-income families in Karachi, Pakistan.

METHODS

Mothers/caregivers of 200 children with asthma and an equal number of children without asthma were interviewed about breastfeeding duration. Based on the responses, 6 different binary variables were constructed: breastfeeding 3 months or less, 6 months or less, 9 months or less, 12 months or less, 18 months or less, and 24 months or less. Asthma status of the child was determined by clinical examination by a primary care physician. Data was analyzed using multiple logistic regression method, adjusted for age and sex of the child, household income, parental ethnicity, number of older siblings, family history of asthma or hay fever, presence of mold, parental smoking, number of people in the household, and body mass index of the child.

RESULTS

The average duration of breastfeeding was 21.4 months (SD = 7.33 months). Breastfeeding for at least 24 months was associated with increased odds of asthma (aOR = 1.77, 95%CI: 0.99, 3.16). Whereas breastfeeding for 12 months or less, and to some extent 18 months or less, was protective against childhood asthma. There was some evidence this protective effect may be delayed in children with a family history of asthma or hay fever.

CONCLUSIONS

This study found breastfeeding for 12 months or less may have a protective effect against asthma. The protective effect weans down after 18 months, and if continued 24 months or more may place the child at-risk of asthma.

Does Couples' Communication Predict Marital Satisfaction, or Does Marital Satisfaction Predict Communication?

The quality of communication between spouses is widely assumed to affect their subsequent judgments of relationship satisfaction, yet this assumption is rarely tested against the alternative prediction that communication is merely a consequence of spouses' prior levels of satisfaction. To evaluate these perspectives, newlywed couples' positivity, negativity, and effectiveness were observed four times at 9-month intervals and these behaviors were examined in relation to corresponding self-reports of relationship satisfaction. Cross-sectionally, relatively satisfied couples engaged in more positive, less negative, and more effective communication. Longitudinally, reliable communication-to-satisfaction and satisfaction-to-communication associations were identified, yet neither pathway was particularly robust. These findings raise important doubts about theories and interventions that prioritize couple communication skills as the key predictor of relationship satisfaction, while raising new questions about other factors that might predict communication and satisfaction and that strengthen or moderate their association.

Trajectories of Economic Disconnection among Families in the Child Welfare System

This study examined economic disconnection, an extreme case of economic exclusion in which families lack both employment and cash assistance, among families in the child welfare system. To build hypotheses about the intersection of the child welfare system and economic disconnection we used a multilevel framework that considers federal policy, local practice, and processes within families. We hypothesized that child welfare intervention has the potential to be a mechanism of economic inclusion or exclusion for vulnerable families, with implications for family reunification. We utilized a novel administrative data set containing data from three state agencies to construct income histories of parents relative to their child's placement in foster care (N = 15,159 parents). We identified eight trajectories using group-based trajectory modeling. About two-thirds of parents experience economic disconnection over a three-year period; these families are least likely to reunify. Although providing economic resources to families is typically beyond the scope of child welfare, efforts to minimize the negative impact of child placement on parents' economic connection is likely to improve both the economic inclusion of poor families and family reunification.

Parent Involvement in Head Start and Children's Development: Indirect Effects Through Parenting

The authors examined the extent to which parent involvement in Head Start programs predicted changes in both parent and child outcomes over time, using a nationally representative sample of 1,020 three-year-old children over 3 waves of the Family and Child Experiences Survey. Center policies that promote involvement predicted greater parent involvement, and parents who were more involved in Head Start centers demonstrated increased cognitive stimulation and decreased spanking and controlling behaviors. In turn, these changes in parenting behaviors were associated with gains in children's academic and behavioral skills. These findings suggest that Head Start programs should do even more to facilitate parent involvement because it can serve as an important means for promoting both parent and child outcomes.