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Introduction Low birth weight (LBW), biological vulnerability that includes preterm birth (PTB) and small for gestational age (SGA), is associated with reduced maternal sensitivity ('making accurate inferences about an infant's physical and emotional needs and responding appropriately') and impaired infant cognitive development. However, research does not examine if preterm birth, SGA, or both drive these associations. This study separated these measures of biological vulnerability to examine associations of LBW, PTB, and SGA with maternal sensitivity and infant cognitive development (controlling for maternal depression, breastfeeding, and demographic covariates). Methods The sample included 6900 9-month-old infants from the Early Childhood Longitudinal Study-Birth Cohort and used birth certificate data, maternal interviews, assessments of maternal sensitivity and infant cognitive development. Multiple linear regressions examined LBW, PTB, and SGA associations with concurrent measures of maternal sensitivity and infant cognition. Results Of the biological vulnerabilities, preterm birth had the strongest negative association with maternal sensitivity (F.sub.1,6450 = 29.48 versus 15.33 and 5.51, ps < .001) and infant cognitive development (F.sub.1,6450) = 390.65 versus 248.02 and 14.43, ps < .001). In the final regression model, preterm birth and maternal sensitivity were uniquely associated with infant cognitive development (R.sup.2 = .05, p < .001), after controlling for maternal depression, breastfeeding, and demographics. Conclusion In this nationally representative infant sample infants, PTB had a stronger negative association with both maternal sensitivity and infant cognitive development in comparison to SGA or LBW. The LBW designation combines infants born preterm with SGA infants, potentially minimizing differences in developmental outcomes of PTB and SGA infants., Author(s): P. Nina Banerjee [sup.1] , Karen McFadden [sup.2] , Jacqueline D. Shannon [sup.2] , Leslie L. Davidson [sup.1] Author Affiliations: (1) grid.21729.3f, 0000000419368729, Department of Epidemiology, Mailman School of [...]

Perinatal HIV infection is associated with delayed neurocognitive development, but less is known about children perinatally HIV-exposed but uninfected (CHEU). We compared cognitive and language outcomes in 4-6-year old CHEU versus children HIV-unexposed and uninfected (CHUU) and children living with HIV (CLHIV). We enrolled 1,581 children (77% of the child population) in five communities in KwaZulu-Natal, South Africa. Children completed: Grover-Counter Scale of cognitive development, sub-scales of the Kaufman Assessment Battery for Children, Reynell Developmental Language Scales. HIV status of children and primary caregivers was determined by repeated rapid tests or report of prior testing. We conducted a cross-sectional multivariable linear regression on 922 dyads with complete data (257 CHEU, 627 CHUU, 38 CLHIV). On all outcome measures, CHEU and CHUU groups had comparable scores; CLHIV scored significantly lower. Emerging global progress toward the elimination of vertical HIV transmission may not only reduce mortality, but also positively impact child development.

We explored the association between household alcohol use and behavior problems among South-African children, using data from the Asenze study, a population-based cohort of South African children and their caregivers. Household alcohol use and child behavior were assessed when children were 6–8 years old. To examine the association, we performed linear regressions. The sample included 1383 children with complete data under the care of 1251 adults. Children living in a household where self-reported caregiver alcohol use was scored as hazardous (4.6%) had higher levels of problem behavior (β = 1.94, 95% CI 0.06–3.82). There were no statistically significant associations between reported hazardous alcohol use by another member of the household (14.5%) and child problem behavior. Hazardous household alcohol use was associated with child problem behavior and this effect appeared to be mainly driven by primary caregiver use. [ABSTRACT FROM AUTHOR]

Background and Objectives Alcohol abuse, a significant health problem in South Africa, affects the ability of adults to care for children. Little is known regarding risky alcohol use among child caregivers there. A large population-based study examined the prevalence of, and factors associated with, risky drinking among caregivers of young children in KwaZulu-Natal, South Africa comparing the use of the Alcohol Use Disorders Identification Test (AUDIT) and the AUDIT-C screens for hazardous or harmful drinking (referred to here as risky drinking). Methods 83 % of child caregivers from five tribal areas were interviewed using the 10-question AUDIT to screen for risky drinking. The AUDIT-C screen, a subset of AUDIT questions, targets alcohol consumption and binge drinking. Factors associated with risky drinking were investigated using logistic regression. Results 1434 caregivers participated, 98 % female. Sixteen percent reported ever drinking alcohol. Based on AUDIT criteria for risky drinking, 13 % of the sample scored as moderate drinkers, 2 % as hazardous users, and 1 % as harmful or dependent users (identifying 3 % as risky drinkers). Using AUDIT-C criteria to identify risky drinking significantly increased the proportion of caregivers identified as risky drinkers to 9 %. In multivariate analyses, factors associated with risky drinking were similar in both screens: partner violence, smoking, HIV-infection, caring for a child with disabilities. Conclusions for Practice Since the AUDIT-C identified risky alcohol use not otherwise detected with the full AUDIT, and since resources for screening in health care settings is limited, the AUDIT-C may be a more appropriate screen in populations where binge drinking is common., Author(s): Myra Taylor[sup.1] , Justin Knox[sup.2] , Meera K. Chhagan[sup.1] [sup.3] , Shuaib Kauchali[sup.1] , Jane Kvalsvig[sup.1] , Claude Ann Mellins[sup.4] , Stephen M. Arpadi[sup.2] [sup.5] , Murray H. Craib[sup.1] [...]

Population-specific data on factors that affect intimate partner violence (IPV) are needed on female adolescents and young adults, a cohort at greatest risk of IPV in the United States (Rennison, 2001). Studies have frequently overlooked the role of relationship communication as a gatekeeper to IPV (Ridley & Feldman, 2003). To address this gap, negative binomial regression was conducted with data from a 2004 survey of 618 women aged 15 to 24 seeking care at an urban reproductive health facility. Findings suggest that, within the previous year, verbal aggression by either partner was associated with physical violence by either or both partners, and verbal reasoning was negatively correlated with physical violence. Bidirectional and unidirectional IPV relationships may employ communication strategies differently. (Contains 4 tables.)

Globally, there is a crucial need to prioritize research directed at reducing neurological, mental health and substance-use disorders in adolescence, which is a pivotal age for the development of self-control and regulation. In adolescence, behaviour optimally advances towards adaptive long-term goals and suppresses conflicting maladaptive short-lived urges to balance impulsivity, exploration and defiance, while establishing effective societal participation. When self-control fails to develop, violence, injury and neurological, mental health and substance-use disorders can result, further challenging the development of self-regulation and impeding the transition to a productive adulthood. Adolescent outcomes, positive and negative, arise from both a life- course perspective and within a socioecological framework. Little is known about the emergence of self-control and regulation in adolescents in low- and middle- income countries where enormous environmental threats are more common (for example, poverty, war, local conflicts, sex trafficking and slavery, early marriage and/or pregnancy, and the absence of adequate access to education) than in high-income countries and can threaten optimal neurodevelopment. Research must develop or adapt appropriate assessments of adolescent ability and disability, social inclusion and exclusion, normative development, and neurological, mental health and substance-use disorders. Socioecological challenges in low- and middle-income countries require innovative strategies to prevent mental health, neurological and substance-use disorders and develop effective interventions for adolescents at risk, especially those already living with these disorders and the consequent disability. Nature527, S161-S166 (19 November 2015), DOI: 10.1038/nature16030 This article has not been written or reviewed by Nature editors. Nature accepts no responsibility for the accuracy of the information provided., Adolescent neurological, mental health and substance-use (NMS) disorders in low- and middle-income countries (LMICs) must be addressed to ensure optimal development of 'human capital' for the future (1). Adolescents, defined [...]

We define neurodevelopment as the dynamic inter-relationship between genetic, brain, cognitive, emotional and behavioural processes across the developmental lifespan. Significant and persistent disruption to this dynamic process through environmental and genetic risk can lead to neurodevelopmental disorders and disability. Research designed to ameliorate neurodevelopmental disorders in low- and middle-income countries, as well as globally, will benefit enormously from the ongoing advances in understanding their genetic and epigenetic causes, as modified by environment and culture. We provide examples of advances in the prevention and treatment of, and the rehabilitation of those with, neurodevelopment disorders in low- and middle-income countries, along with opportunities for further strategic research initiatives. Our examples are not the only possibilities for strategic research, but they illustrate problems that, when solved, could have a considerable impact in low-resource settings. In each instance, research in low- and middle-income countries led to innovations in identification, surveillance and treatment of a neurodevelopmental disorder. These innovations have also been integrated with genotypic mapping of neurodevelopmental disorders, forming important preventative and rehabilitative interventions with the potential for high impact. These advances will ultimately allow us to understand how epigenetic influences shape neurodevelopmental risk and resilience over time and across populations. Clearly, the most strategic areas of research opportunity involve cross-disciplinary integration at the intersection between the environment, brain or behaviour neurodevelopment, and genetic and epigenetic science. At these junctions a robust integrative cross- disciplinary scientific approach is catalysing the creation of technologies and interventions for old problems. Such approaches will enable us to achieve and sustain the United Nations moral and legal mandate for child health and full development as a basic global human right. Nature 527, S155-S160 (19 November 2015), DOI: 10.1038/nature16029 This article has not been written or reviewed by Nature editors. Nature accepts no responsibility for the accuracy of the information provided., One evaluation of early childhood developmental status in low- and middle-income countries (LMICs) estimates that 15.7% of children are significantly delayed in their cognitive development, 26.3% in socioemotional development and [...]

Acculturation has been shown to positively and negatively affect Latino health. Little research investigates the overlap between acculturation and the different types of relationship violence among Latino youth and most research in this area predominantly involves Mexican-American samples. The current study examined associations between indices of acculturation (language use at home, chosen survey language, and nativity) and relationship physical violence and sexual coercion, both received and delivered, among predominantly Dominican and Puerto Rican adolescents from New York City. From 2006 to 2007, 1,454 adolescents aged 13-21 years in New York City completed an anonymous survey that included the Conflict in Adolescent Relationships Inventory which estimates experiences of physical violence and sexual coercion, both received and delivered, in the previous year. This analysis includes bivariate and multivariate methods to test the associations between language use at home, chosen survey language, and nativity with the different types of relationship violence. Among females, there is a significant association between language use at home and overall level of acculturation with delivering and receiving relationship physical violence; however, we did not find this association in delivering and receiving relationship sexual coercion. We found no association between acculturation and any type of relationship violence among males. Among Latina females, language spoken at home is an indicator of other protective factors of physical relationship violence. Future research in this area should explore the potential protective factors surrounding relationship violence among Latina females of various subgroups using comprehensive measures of acculturation, household composition and family engagement., Author(s): Melissa DuPont-Reyes[sup.1] , Deborah Fry[sup.2] , Vaughn Rickert[sup.3] , Leslie L. Davidson[sup.1] [sup.4] [sup.5] Author Affiliations: (1) Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West [...]

Given the existing evidence linking parental depression with infant and early child development, our aim was to describe the burden of mental health disorders among caregivers of young children aged 4-6 years living in an environment of poverty and high HIV seroprevalence. We analyzed baseline data from an epidemiologic study of the health and psychosocial needs of preschool-aged children. Primary caregivers of index children recruited from a household survey were screened for common mental disorders using the Client Diagnostic Questionnaire (CDQ). Sociodemographic, HIV and general health surveys were also conducted. Many caregivers (449/1,434; 31.3 %) screened positive for at least one psychiatric disorder on the CDQ, with post-traumatic-stress-disorder being the most common. Caregivers who screened positive for any disorder were more likely to be older, to have no individual sources of income and to have less formal education. Presence of a disorder was also significantly associated with lower employment levels within the household and death of a young child within the household. Known HIV-infected caregivers were more likely to have any mood disorder than caregivers who previously tested negative. The data support the need for mental health treatment interventions in South Africa, particularly interventions directed at PTSD and depression, and that take into account the high burden of poverty, HIV and childhood mortality. Given the limited formal mental health structure in South Africa to address these highly prevalent disorders; community-based mental health supports, available through decentralized health systems many be critical to delivering accessible interventions., Author(s): Meera K. Chhagan [sup.1] , Claude A. Mellins [sup.2] , Shuaib Kauchali [sup.1] , Murray H. Craib [sup.1] , Myra Taylor [sup.3] , Jane D. Kvalsvig [sup.3] , Leslie [...]

Background: Adverse childhood events (ACEs) are associated with negative health effects in adulthood. Despite knowledge of these later impacts, little is known about the earlier effect of ACEs on later child behaviour in low‐ and middle‐income countries (LMIC). Methods: The population‐based Asenze cohort study was implemented in a peri‐rural area of KwaZulu‐Natal, South Africa, comprising five Zulu tribal areas. Two waves of data were examined: family information and ACEs exposure when children were on average 5 years old and child behaviour problems (Strengths and Difficulties Questionnaire [SDQ]) approximately 2 years later (average age 7 years). Logistic regression analysis was used to examine unadjusted and adjusted relationships between cumulative ACEs experienced and the SDQ total scores (dichotomized as top 10% vs. the rest) as well as selected SDQ subscales. Results: A significant relationship between increased ACE exposure and SDQ total score was observed. The same relationship was also seen for the SDQ emotional symptoms and conduct problem subscales, but not for hyperactivity. The results of a sensitivity analysis excluding intimate partner violence from the ACEs measure demonstrated similar results. Conclusions: There is an association between exposure to ACEs and later child behaviour problems within this LMIC population demonstrating an early negative impact for ACEs. While previous research has focused on the effects of ACEs on adult health, this study provided evidence for an earlier relationship between ACEs and child behaviour problems that may be a part of the mechanism through which later health effects arise. [ABSTRACT FROM AUTHOR]

Objectives. This study evaluated the effectiveness of a community coalition to prevent severe injuries to children in Central Harlem, New York, NY. It was hypothesized that injury incidence rates would decline during the intervention (1989 through 1991) relative to preintervention years (1983 through 1988); that the decline would be greatest for the targeted age group (5 through 16 years) and targeted injury causes (traffic accidents, assaults, firearms, outdoor falls); and that the decline would occur in the intervention community rather than a control community. Methods. Surveillance of injuries that result in hospitalization and/or death among children in the two communities has been under way since 1983. Data from this surveillance were used to test whether the incidence of severe injury declined during the intervention; other temporal variations were controlled by Poisson regression. Results. The incidence of injury among school-aged children in central Harlem declined during the intervention. The decline was specific to the targeted age group and targeted causes. A nonspecific decline also occurred in the control community. Conclusions. The declining incidence rate in Central Harlem is consistent with a favorable program effect, but additional investigation of possible secular trend or spillover effects is needed. (Am J Public Health. 1994;84:580-586), Community programs specifically aimed at reducing injuries to school-age children appear to have mixed results. The Safe Kids/Health Neighborhood Coalition in Central Harlem, New York City, was designed to reduce injuries to children aged 5-17. The methods used included cleaning up and repairing playgrounds, teaching pedestrian safety, providing supervised activities and providing inexpensive safety equipment in the form of bicycle helmets. In the first three years, from 1989 through 1991, the program appears to have reduced overall injuries to school age children, compared to earlier years. Injury rates among younger children on whom the program did not focus remained similar to earlier years. However, motor vehicle injury rates, a particular focus, fell in neighboring Washington Heights also. Little change in outdoor falls was found, despite more supervision and improved play areas. Additional research from more specific records and with methods to control for confounding changes is needed.

Objectives. The purpose of this study was to investigate the relationship between socioeconomic disadvantage and the incidence of severe childhood injury. Methods. Small-area analysis was used to examine socioeconomic risk factors for pediatric injury resulting in hospitalization or death in Northern Manhattan, New York, NY, during a 9-year period (1983 through 1991). Results. The average annual incidence of all causes of severe pediatric injury was 72.5 per 10 000 children; the case-fatality rate was 2.6%. Census tract proportions of low-income households, single-parent families, non-high school graduates, and unemployment were significant predictors of risk for both unintentional and intentional injury. Among the socioeconomic factors considered, low income was the single most important predictor of all injuries; other socioeconomic variables were not independent contributors once income was included in the model. Compared with children living in areas with few low-income households, children in areas with predominantly low-income households were more than twice as likely to receive injuries from all causes and four and one half times as likely to receive assault injuries. The effect of neighborhood income disparities on injury risk persisted after race was controlled. Conclusions. These results illuminate the impact of socioeconomic disparities on child health and point to the need for injury prevention efforts targeting low-income neighborhoods. (Am J Public Health. 1994;84:587-592), Poor children may be more likely to be victims of severe injuries than are other children. Injury to children from accidents or assaults is becoming a major public health issue. While most research focuses on deaths from injury, the more common occurrence is severe, but nonfatal, injury. A study of the 1983-1991 hospitalization records from Central Harlem and Washington Heights in New York City reveals a pediatric injury rate of 72.5 per 10,000 children. This study indicates that avoidable accidents and injury happen to all children. However, those who live in low-income neighborhoods such as these in northern Manhattan and those living with single parents are at much greater risk. Children in these poor neighborhoods are two times as likely to be injured in any way and are at greater risk for each kind of injury studied. They also are more than four times as likely to be injured by assault.

Objectives. A prospective study of children examined both before and after a flood disaster in Bangladesh is used to test the hypothesis that stressful events play a causal role in the development of behavioral disorders in children. Methods. Six months before the disaster, structured measures of selected behavioral problems were made during an epidemiological study of disability among 2- to 9-year-old children. Five months after the disaster, a representative sample of 162 surviving children was reevaluated. Results. Between the pre- and postflood assessments, the prevalence of aggressive behavior increased from zero to nearly 10%, and 45 of the 134 children who had bladder control before the flood (34%) developed enuresis. Conclusions. These results help define what may be considered symptoms of posttraumatic distress in childhood; they also contribute to mounting evidence of the need to develop and evaluate interventions aimed at ameliorating the behavioral and psychological consequences of children's exposure to extreme and traumatic situations., Specific interventions may be needed to lessen the psychological impact of stressful events on children. Children in flood-prone Bangladesh were studied before and after such an event to determine the role of stress in childhood behavioral problems. Using structured criteria for measuring such problems, children two to nine years old were studied for indications of disability six months before the floods. Five months after the floods, 162 survivors were evaluated once more. Researchers found that the survivors' aggressive behavior had increased from none to almost 10% and that bladder control had been lost in 34% of children who had it before the flood. These findings were interpreted as being manifestations of posttraumatic stress syndrome.

* The weights and heights of 1670 Harlem children aged 5 to 11 years (879 boys, 791 girls) were compared with the National Center for Health Statistics standards. The median height for age and weight for age were greater by 1.4 cm and 2.2 kg in boys and 2.7 cm and 2.8 kg in girls. Weight distribution was skewed to the right and showed a bimodal pattern. 'Height-ages' were advanced by an average of 0.24 years in boys and 0.47 years in girls. Weight for height in 13.9% of girls and 13.6% of boys were above the 95th percentile. The results are consistent with early maturation. However, even after adjusting for height, shift to the right of the weight distribution persists with a large subgroup of boys and girls who are overweight., A significant percentage of inner-city school children appear to be overweight. Of 879 boys and 791 girls aged five to 11 in three elementary schools in Central Harlem, NY, 88% were black and the other 12% were Hispanic. Overall the children were taller and heavier for their age than standards from the National Center for Health Statistics (NCHS). In boys, the average height for age and the average weight for age were 1.4 centimeters (cm) and 2.2 kilograms (kg) greater than the NCHS standards. In girls, the average height for age and the average weight for age were 2.7 cm and 2.8 kg greater than the NCHS standards. Furthermore, a significant percentage of both boys and girls were overweight. When the children's weight for height values were compared with their weight for age, more boys and fewer girls were considered overweight. Early maturation, especially among girls, may explain some of the findings.

Iron-deficiency anemia is a decrease in red blood cells due to an insufficient supply of iron stores. The incidence of this disorder among children is decreasing due to the supplementation of iron in formulas and cereals. Nevertheless, many children from low-income homes have reduced levels of hemoglobin (Hgb), the oxygen-carrying pigment of red blood cells, which may indicate a deficiency of iron in the diet. Children from poor backgrounds have a greater risk of developing anemia than children from families living above the poverty level, and the prevalence of anemia appears to be related to socioeconomic status. A diagnosis of iron deficiency anemia is assumed when children with Hgb levels of less than 11 grams per deciliter (g/dL) respond to treatment with iron supplements in the diet. However, it is not clear whether dietary iron supplements actually improve Hgb levels. Hence, the effect of dietary iron supplements on Hgb levels was assessed in 334 six-month-old infants with Hgb levels between 9 and 11.5 g/dL. The infants were from inner-city minority families. Doses of 3 or 6 milligrams/kilogram (mg/kg) of iron or no iron supplements were given each day for three months. The results showed that Hgb levels increased with age, and Hgb levels increased by 1 g/dL or more in 34 percent of infants. All infants had similar increases in Hgb levels and values for indicators of red blood cell content. Hence, additional iron supplements in the diet do not appear to yield further improvements in Hgb levels. Screening for iron-deficiency anemia at six months of age is unnecessary among infants fed an iron-fortified formula. In addition, the treatment of low-income infants who have low Hgb levels with additional iron supplements, without considering their diet, is also unnecessary. (Consumer Summary produced by Reliance Medical Information, Inc.)