The impact of early childhood interventions on mothers Evans, David K; Jakiela, Pamela; Knauer, Heather A
Science (American Association for the Advancement of Science),
2021-May-21, 2021-05-21, 20210521, Volume:
372, Issue:
6544
Journal Article
Peer reviewed
Failure to measure the impacts on women's time and other maternal outcomes implicitly sets their value at zero
Over 250 million children in low- and middle-income countries (LMICs) are at risk of ...failing to meet their developmental potential, primarily because of a lack of adequate nutrition and stimulation in early childhood (
1
). Well-designed early childhood development (ECD) interventions can have substantial impacts on children's physical, cognitive, and socioemotional development, as well as their eventual schooling attainment, wages, and other outcomes (
1
–
3
). Although the potential indirect effects of interventions on mothers and other household members are generally acknowledged, few studies explicitly quantify outcomes related to labor market activities, health, or well-being of household members other than young children. This may lead policy-makers to overinvest in programs that impose substantial costs on women and to underinvest in those that improve women's well-being. Systematically ignoring impacts on specific subgroups—particularly vulnerable groups such as women in LMICs—risks exacerbating inequalities in the name of evidence-based policy.
Fathers contribute to their children's health starting at the beginning of life. Few parent education programs include fathers. Among those that do, there is little effort to report program effects ...on father outcomes.
In this systematic review, we examined father-inclusive perinatal parent education programs in the United States as they relate to a range of father outcomes.
The databases searched were PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, and PsycINFO.
Studies were included if they included an evaluation of a parent education program and a report of father outcomes measured within 1 year of the child's birth and were conducted within the United States.
Of 1353 total articles, 21 met study criteria.
The overall state of the father-inclusive perinatal parent education program literature was poor, with few interventions available to fathers. Available programs were associated with increased father involvement, coparenting relationship, partner relationship quality, father's mental health, and father's supportive behaviors. Program effects on father-infant interaction, parenting knowledge, and attitudes and parenting self-efficacy were inconclusive. Three programs emerged as best evidence-based interventions.
Risk of bias was high for many studies. Outcome variability, small sample size, and publication bias contributed to the weak evidence base.
There is a need for more evidence-based interventions to support fathers. Clinicians play a key role in engaging fathers in early parent education programs and health care settings. PROSPERO registration number: CRD42017050099.
We examined effects on child development of a group-based parenting support program (Educación Inicial - EI) when combined with Mexico's conditional cash transfer (CCT) program (Prospera, originally ...Oportunidades and Progresa). This cluster-randomized trial included 204 communities (n = 1,113 children in final sample), stratified by community indigenous status, and assigned to receive either: (T0) CCT only; (T1) CCT plus availability of EI in the community; or (T2) T1 plus promotion of the EI program by the CCT program. Interviews were conducted with the mother or primary caregiver of each child at baseline (2008, children 0-18 months old), and at follow-up (2012, children 3-5 years old); the intervention began after baseline and continued for all eligible households. Cognitive development was assessed with the Extended Ages and Stages Questionnaire (baseline) and the McCarthy Scales of Children's Development (follow-up); assessors were blinded to treatment. All analyses were intention to treat. There were significant effects on child development when EI received support and promotion from the CCT program (T2 vs. T0: General Cognitive Index, β = 3.90; 95% CI 0.51, 7.30, Verbal Score, β = 4.28; 95% CI 0.51, 8.05, and Memory Score, β = 4.14; 95% CI 0.62, 7.66), effects equivalent to 0.26-0.29 SD. There were no significant benefits when the programs operated independently (T1 vs. T0). In stratified analyses, EI showed significant effects in indigenous communities only. We found consistent results in regressions controlling for covariates, with some reductions in magnitude of differences. Our findings suggest that group-based, parenting support programs can improve child outcomes within the context of a CCT, but only when the 2 programs are integrated and mutually supportive.
•Homes in rural Kenya lack storybooks that could support children’s early literacy.•We conducted a cluster-randomized trial of combinations of books and training.•Dialogic reading training (DRT) can ...improve the quality of parent–child reading.•Books and DRT yield vocabulary gains for children with illiterate caregivers.•More intensive intervention variants did not markedly increase impacts.
Worldwide, 250 million children under five (43%) are not meeting their developmental potential because they lack adequate nutrition and cognitive stimulation in early childhood. Several parent support programs have shown significant benefits for children’s development, but the programs are often expensive and resource intensive. The objective of this study was to test several variants of a potentially scalable, cost-effective intervention to increase cognitive stimulation by parents and improve emergent literacy skills in children. The intervention was a modified dialogic reading training program that used culturally and linguistically appropriate books adapted for a low-literacy population. We used a cluster randomized controlled trial with four intervention arms and one control arm in a sample of caregivers (n?=?357) and their 24- to 83-month-old children (n?=?510) in rural Kenya. The first treatment group received storybooks, while the other treatment arms received storybooks paired with varying quantities of modified dialogic reading training for parents. Main effects of each arm of the trial were examined, and tests of heterogeneity were conducted to examine differential effects among children of illiterate vs. literate caregivers. Parent training paired with the provision of culturally appropriate children’s books increased reading frequency and improved the quality of caregiver-child reading interactions among preschool-aged children. Treatments involving training improved storybook-specific expressive vocabulary. The children of illiterate caregivers benefited at least as much as the children of literate caregivers. For some outcomes, effects were comparable; for other outcomes, there were differentially larger effects for children of illiterate caregivers.
Altered systolic blood flow in the ascending aorta has been correlated with increased aortic growth in patients with bicuspid aortic valves (BAVs). We used conventional, 2-dimensional (2D) phase ...contrast magnetic resonance imaging (PC-MRI) to assess the relationship between altered flow and future growth in patients with BAV.
Aortic MRI data were reviewed for 17 adult patients with BAV with right-left leaflet fusion undergoing surveillance imaging who had 2D PC-MRI through their ascending aortas on an initial study, follow-up studies more than 1 year later, and an initial maximum aortic diameter of less than 4.5 cm. Diameters were measured at standard levels by 2 blinded reviewers. Normalized systolic flow displacement was calculated at peak systole from the PC-MRI data, and correlation with the interval aortic growth was performed, with adjustment for clinical/demographic factors.
The average follow-up interval was 2.9 ± 1.3 years. Systolic flow displacement at the initial study strongly correlated with ascending aortic growth rate (r = 0.71, P < 0.005) with moderate, non-significant correlation between initial diameter and growth (r = 0.45, P = 0.214). Aortic growth was 4 times faster in patients with initial flow displacement of 0.2 or greater (n = 9) compared with those (n = 8) with initial flow displacement less than 0.2 (0.8 ± 0.4 vs 0.2 ± 0.3 mm/y; P = 0.002).
Systolic flow displacement calculated from conventional 2D PC-MRI in the ascending aorta correlates with future aortic growth in patients undergoing routine surveillance imaging for BAV. With a cutoff valve of 0.2, flow displacement may be used to identify a subset of patients likely to have elevated growth rates and may better risk-stratify patients with BAV for aortic disease progression than vessel diameter alone.
In many low‐ and middle‐income countries, young children learn a mother tongue or indigenous language at home before entering the formal education system where they will need to understand and speak ...a country's official language(s). Thus, assessments of children before school age, conducted in a nation's official language, may not fully reflect a child's development, underscoring the importance of test translation and adaptation. To examine differences in vocabulary development by language of assessment, we adapted and validated instruments to measure developmental outcomes, including expressive and receptive vocabulary. We assessed 505 2‐to‐6‐year‐old children in rural communities in Western Kenya with comparable vocabulary tests in three languages: Luo (the local language or mother tongue), Swahili, and English (official languages) at two time points, 5–6 weeks apart, between September 2015 and October 2016. Younger children responded to the expressive vocabulary measure exclusively in Luo (44%–59% of 2‐to‐4‐year‐olds) much more frequently than did older children (20%–21% of 5‐to‐6‐year‐olds). Baseline receptive vocabulary scores in Luo (β = 0.26, SE = 0.05, p < 0.001) and Swahili (β = 0.10, SE = 0.05, p = 0.032) were strongly associated with receptive vocabulary in English at follow‐up, even after controlling for English vocabulary at baseline. Parental Luo literacy at baseline (β = 0.11, SE = 0.05, p = 0.045) was associated with child English vocabulary at follow‐up, while parental English literacy at baseline was not. Our findings suggest that multilingual testing is essential to understanding the developmental environment and cognitive growth of multilingual children.
Children's receptive vocabulary in their mother tongue language is the strongest predictor of vocabulary in other languages after accounting for same language associations between time periods (e.g., English at baseline to English at followup). Younger children primarily express themselves predominantly in their mother tongue language, but the proportion of their expressive vocabulary in their second language increases with age. Multilingual testing is essential to fully capture the developmental environment and cognitive growth of multilingual children.
Abstract Background Few studies have investigated pediatrician attitudes about providing primary medical care for children with special health care needs. The objective of this study was to determine ...pediatrician perspectives on their comfort level in providing care and on where the medical home should be for children with chronic medical and developmental conditions. Methods Survey of pediatricians in California in 2014. Pediatricians were randomized to receive surveys featuring either a case of a child with a chronic medical (neurofibromatosis) or a developmental condition (autism). They were then asked about their comfort level in providing primary care for the child. We developed logistic regression models to adjust for practice and provider factors, and availability of family social resources. Results The survey response rate was 50.2%. Primary care pediatricians expressed more comfort than nonprimary care pediatricians in providing a medical home for a child with chronic medical or developmental condition (range, 84%–92% comfortable vs 58%–79% comfortable), respectively. All pediatricians expressed more comfort providing care for a child with autism than neurofibromatosis. Nearly all primary care pediatricians (90%) believed that the medical home should be in pediatric primary care practice. Pediatrician comfort in becoming a medical home was higher when the family had more social resources. Conclusions Most pediatricians endorse that the medical home for children with special health care needs be in the primary care setting. Improving access to subspecialty care and providing resources, such as case management, to address family social complexity might raise pediatrician comfort in providing primary care to children with medical and developmental conditions.
Background and Objectives
Pediatricians face numerous challenges in providing care for children with special health care needs (CSHCN). Few studies have described health care resources available to ...support pediatricians to care for CSHCN. This study investigated available resources to care for CSHCN and factors associated with having a greater proportion of CSHCN in practice.
Methods
We conducted a statewide survey of active members of the American Academy of Pediatrics in California to study pediatric subspecialty care access, community and office resources and practice barriers. We performed a logistic regression model on having an “above average proportion” of CSHCN in practice, adjusting for demographics, practice type (rural vs. suburban/urban) and medical resources, care satisfaction, and ease of subspecialty access.
Results
Our response rate was 50.2% (
n
= 1290); 75% of respondents reported providing some primary care services, with many primary care pediatricians caring for a high proportion of CSHCN. Pediatricians reported an average of 28% CSHCN in their practices. Rural pediatricians lacked subspecialty access (10–59% reporting no access to the various subspecialties). Factors relating to higher CSHCN in practice included being in academic medical centers and satisfaction in caring for CSHCN.
Conclusions
Pediatricians report lack of access to mental health services, care coordination and case management. Academic medical centers and higher physician satisfaction in care delivery for CSHCN are associated with more CSHCN in practice. Promoting ways to support pediatricians, such as practice collaboration with behavioral specialists, may be necessary to encourage primary care pediatricians to provide medical homes for CSHCN.
Parenting may be influenced by ethnicity; marginalization; education; and poverty. A critical but unexamined question is how these factors may interact to compromise or support parenting practices in ...ethnic minority communities. This analysis examined associations between mothers' stimulating parenting practices and a range of child-level (age; sex; and cognitive and socio-emotional development); household-level (indigenous ethnicity; poverty; and parental education); and community-level (economic marginalization and majority indigenous population) variables among 1893 children ages 4-18 months in poor; rural communities in Mexico. We also explored modifiers of associations between living in an indigenous community and parenting. Key findings were that stimulating parenting was negatively associated with living in an indigenous community or family self-identification as indigenous (β = -4.25; SE (Standard Error) = 0.98; β = -1.58; SE = 0.83 respectively). However; living in an indigenous community was associated with significantly more stimulating parenting among indigenous families than living in a non-indigenous community (β = 2.96; SE = 1.25). Maternal education was positively associated with stimulating parenting only in indigenous communities; and household crowding was negatively associated with stimulating parenting only in non-indigenous communities. Mothers' parenting practices were not associated with child sex; father's residential status; education; or community marginalization. Our findings demonstrate that despite greater community marginalization; living in an indigenous community is protective for stimulating parenting practices of indigenous mothers.
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