Place-based Social Determinants of Health Associated with Multiple Early Childhood Educational Outcomes

Background: Exposure to parental chronic illness is associated with several adverse developmental outcomes. Objectives: We examined the association between parental multiple sclerosis (MS) and childhood developmental outcomes. Methods: We conducted a population-based retrospective cohort study in Manitoba, Canada, using linked databases. The outcome was childhood development at 5 years of age, expressed as vulnerability (absent vs. present) on the Early Development Instrument (EDI). Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Results: Children with an MS parent (n=153) were similar to children of unaffected parents (n=876) on all EDI domains. However, mental health morbidity was more common among MS parents compared with non-MS parents 49.5% vs. 35.3%. Among MS parents, mental health morbidity was associated with children’s vulnerability on the social competence (OR, 5.73 [95% CI:1.11–29.58]) and emotional maturity (OR, 3.03 [95% CI:1.03–8.94]) domains. The duration of child’s exposure to parental MS was associated with vulnerability on the physical health domain (OR, 1.49 [95%CI:1.03–2.15]). Conclusion: Parental MS was not associated with adverse early childhood developmental outcomes. However, children of parents with mental health morbidity, and those with longer duration of exposure to parental MS, were at higher risk for early childhood developmental vulnerability.

Addressing Social Determinants of Mental Health in Pediatrics During the Coronavirus Disease 2019 Pandemic.

Ten years have passed since the release of the final report of the World Health Organization (WHO) Commission on Social Determinants of Health (CSDH),1 a landmark document that provided a global blue‐print for the health promotion community and the stakeholders we work with. Three overarching recommendations were outlined, improving daily living conditions; tackling the inequitable distribution of power, money and resources; and measuring and understanding the problem and assessing the impact of action.1 The extent to which progress has been, and continues to be, made is contested. This editorial briefly reflects on what has been achieved over the past decade—in broad terms—about action on the social determinants of health (SDH) in Australia. We deliberately take a balanced view by highlighting the weaknesses and strengths in what has been achieved by governments, non‐government organisations, research institutions, peak bodies and civil society. We also reflect on the ongoing role that the Australian Health Promotion Association (AHPA) has played in advancing our understanding about, and action on, the SDH.

Academic health centers (AHCs) in the United States have had a leading role in educating the medical workforce, generating new biomedical knowledge, and providing tertiary and quaternary clinical care. Yet the health status of the U.S. population lags behind almost every other developed world economy. One reason is that the health care system is not organized optimally to address the major driver of health status, the social determinants of health (SDOH). The United States' overall poor health status is a reflection of dramatic disparities in health that exist between communities and population groups, and these are associated with variations in the underlying SDOH. Improving health status in the United States thus requires a fundamental reengineering of the health delivery system to address SDOH more explicitly and systematically. AHCs' tripartite mission, which has served so well in the past, is no longer sufficient to position AHCs to lead and resolve the intractable drivers of poor health status, such as unfair and unjust health disparities, health inequities, or differences in a population's SDOH.AHCs enjoy broad public support and have an opportunity-and an obligation-to lead in improving the nation's health. This Perspective proposes a new framework for AHCs to expand on their traditional tripartite mission of education, research, and clinical care to include explicitly a fourth mission of social accountability. Through this fourth mission, comprehensive community engagement can be undertaken, addressing SDOH and measuring the health impact of interventions by using a deliberate structure and process, yielding defined outcomes.

BACKGROUND: Poverty is associated with multiple adverse perinatal outcomes including low birth weight, small for gestational age, pregnancy induced hypertension, gestational diabetes as well as an increased risk for neonatal death. Recent research has attempted to align social theory (i.e., that adverse social exposures impact multiple outcomes) with new statistical modeling that reflects this theory. The Generalized Health Impact (GHI) model looks at the impact on a myriad of adverse outcomes of exposure to negative social risk factor such as low income or poverty. Growing research examines how multiple perinatal outcomes are influenced by social and material deprivation. In particular, having a lower social and economic position in society (socioeconomic position) or being raised in low-income setting has been independently linked to multiple negative health outcomes. OBJECTIVES: To understand the generalized health impact (GHI) on perinatal health for mothers and their children that socioeconomic position (SEP) can have on health. DESIGN/METHODS: Data from the Nova Scotia Atlee Perinatal Database was used. A partnership with Statistics Canada facilitated a confidential linkage with income tax information for the year in which delivery occurred. Multiple logistic regression models were used to examine the relationship between multiple indicators of family income and multiple adverse perinatal and maternal outcomes. In the second stage of analysis, multinomial logistic regression was used to examine effects on a tally of the number of adverse outcomes (0, 1, 2 or ≥3). The study was approved by the IWK Health Centre Research Ethics Board. RESULTS: 117 734 individuals were included. Total family income was less than $23 587 in approximately 62% of families. Effect of low socioeco-nomic position on concomitant adverse perinatal health outcomes was seen with the risk of having 3 or more conditions was highest amongst single mothers (PR 3.1 CI: 2.92-3.27) and families reported as having an income below the low income cut off (PR 2.33 CI:2.16-2.51). Higher material deprivation in the neighbourhood of residence was associated with increased risk of multiple negative perinatal outcomes including pre-term birth and small for gestational age. CONCLUSION: This study highlights the importance of understanding the cumulative effect of SEP on generalized health outcomes for negative perinatal health outcomes. This research should inform clinical practice to recognize that social determinants of health and negative health outcomes occur not in isolation but as a collective. Further research on adequate screening for poverty and clinical assessment of social determinants of health is required.

Early Childhood Health and Education Outcomes and Children's Exposure to Multiple Risks in Turkey

Objective: African-American, Hispanic, and poor children are at the utmost risk of experiencing adverse health and educational outcomes. Research has demonstrated that health and education disparities occur within the context of social determinants of health. The purpose of this study was to examine the relationship between social determinants of health and health and educational disparities that begin early childhood. Methods: Using data from the 2011/ 2012 National Survey of Children’s Health the sample for the current study included data for 1496 African-American and 2451 Hispanic children 3 - 5 years of age. Indicators of potential health and education disparities included measures of access to healthcare, measures of health and dental health, and measures of early childhood experiences. Results: The findings revealed that African-American, Hispanic, and poor children experienced more significant disparities in health and early childhood outcomes than their White and wealthier peers and that neighborhood risks were related to poorer health and educational outcomes. Conclusions: The results suggest that ensuring health equity and reducing health and educational disparities during early childhood can only occur by focusing on upstream determinants of health which include risk exposure, social disadvantage, and social inequities.

Understanding Social Determinants of Brain Health During Development.

Back to table of contents Previous article Next article Clinical & ResearchFull AccessAnalysis Identifies Key Components in Adolescent Mental Health CareTerri D’ArrigoTerri D’ArrigoSearch for more papers by this authorPublished Online:14 Aug 2019https://doi.org/10.1176/appi.pn.2019.8b22AbstractInterventions that aim to develop interpersonal skills deliver the most consistent positive results across multiple outcomes.A meta-analysis in Pediatrics has found that three components of adolescent mental health programs are consistently effective across multiple outcomes: those geared toward improving interpersonal skills, developing emotional regulation, and providing alcohol and drug education.Sarah Skeen, Ph.D., a senior researcher at Stellenbosch University in South Africa, and colleagues analyzed data from 158 studies of psychosocial interventions administered to adolescents aged 10 to 19 years old. They found that components that focused on building interpersonal skills consistently delivered positive results across multiple outcomes, notably on overall mental health, depression and anxiety prevention, and substance use prevention.“Developing skills to improve interpersonal relationships is highly relevant for improving adolescent mental health outcomes, and our findings indicate that including these skills in multi-outcome interventions designed to promote mental health and prevent mental disorders and risk behaviors is a valuable strategy,” the researchers wrote.Components focused on teaching adolescents emotional regulation improved mental health and reduced symptoms of depression and anxiety. Alcohol and drug education had positive effects on mental health and aggression. However, this education was not associated with a positive effect on substance use, for reasons unknown to the researchers.To ensure culturally appropriate implementation of mental health interventions for adolescents, low- and middle-income countries should determine how best to apply the interventions themselves, says Molly McVoy, M.D.in South Africa, and colleagues analyzed data from 158 studies of psychosocial interventions administered to adolescents aged 10 to 19 years old. They found that components that focused on building interpersonal skills consistently delivered positive results across multiple outcomes, notably on overall mental health, depression and anxiety prevention, and substance use prevention.“Developing skills to improve interpersonal relationships is highly relevant for improving adolescent mental health outcomes, and our findings indicate that including these skills in multi-outcome interventions designed to promote mental health and prevent mental disorders and risk behaviors is a valuable strategy,” the researchers wrote.Components focused on teaching adolescents emotional regulation improved mental health and reduced symptoms of depression and anxiety. Alcohol and drug education had positive effects on mental health and aggression. However, this education was not associated with a positive effect on substance use, for reasons unknown to the researchers.Molly McVoy, M.D., a training director and assistant professor of child and adolescent psychiatry at University Hospitals in northeast Ohio, noted the practical implications of the research. “Every psychiatrist who works with teenagers can put interpersonal relationship-building skills and emotional regulation at the top of the list [to achieve] for resilience,” said McVoy, who was not involved in the research.The meta-analysis was conducted to aid the development of a universally delivered intervention as part of the Helping Adolescents Thrive initiative, which is sponsored by the World Health Organization and the United Nations Children’s Fund. To that end, the study authors noted an important caveat to their findings: Nearly all of the studies in the meta-analysis were conducted in high-income countries. Therefore, it will be essential to track implementation if and when these interventions are adapted for use in low- and middle-income countries to ensure that they are implemented in culturally appropriate ways, the researchers wrote.McVoy suggested that the best way to ensure culturally appropriate implementation is for low- and middle-income countries to determine how to apply the components themselves. “More wealthy countries coming in and trying to insert their approach, even if it’s evidence based, is not sustainable and does not go well,” she said. In a commentary accompanying the study, Glenn Thomas, Ph.D., of the Department of Psychiatry and Behavioral Health at Nationwide Children’s Hospital in Columbus, Ohio, wrote that effective implementation and sustainability may require resources that are unavailable in low-income communities.“This maintains disparity in access to mental health resources, with the unintended consequence being that economically marginalized families are even less likely to be exposed to high-quality interventions,” Thomas wrote. “If we are to close the gap in social determinants of health, a concerted effort to fund and implement prevention and evaluate effectiveness and transportability is imperative.”This study was funded by the World Health Organization. ■“Adolescent Mental Health Program Components and Behavior Risk Reduction: A Meta-Analysis” is posted here. “Universal Mental Health Prevention for Adolescents: Real-World Implications” is posted here. ISSUES NewArchived

Location, Location, Location: Teaching About Neighborhoods in Pediatrics

This report focuses on how speech perception, speech production, language, and literacy performance in adolescence are influenced by a common set of predictor variables obtained during elementary school in a large group of teenagers using cochlear implants (CIs). Time-lag analyses incorporating seven common predictor variables associated with the elementary school test period were evaluated. The elementary school-age variables included five contributors across the performance domains: gender, performance intelligence quotient, family size, socioeconomic status, and duration of deafness (operationally defined as the time period between the age of implantation and the onset of deafness). Regression analyses then examined how communication mode in early elementary grades influenced skills exhibited in high school and how this influence was mediated by information capacity of immediate memory. High correlations occurred between outcome measures collected at CI-E session and similar measures collected at CI-HS (values ranging from 0.75 to 0.83), indicating that the relative standing of individuals on these outcomes is highly stable over time. The best performers in elementary grades exhibit the best outcomes in high school, and early difficulties tend to persist throughout the elementary and high school years. The most highly related outcome areas were language and reading/literacy (values ranging from 0.74 to 0.88). These skills seem closely linked, and CI children who demonstrate the best vocabulary and syntax skills in elementary grades achieved the highest literacy performance in high school. Speech perception and speech production skills are also highly correlated with one another (r = 0.69 to 0.87), suggesting that the most direct result of improved auditory input from a CI is the child's ability to produce intelligible speech. The lowest correlations are observed between reading/literacy and speech perception (r = 0.30 to 0.54) or speech production (values ranging from 0.31 to 0.58). CI-E verbal rehearsal speed is an independent and powerful predictor of each early performance outcome, accounting for between 13% and 30% of the variance in early outcomes above and beyond that accounted for by gender, family size, socioeconomic status, performance intelligence quotient, duration of deafness, and the CI-E sign enhancement ratio. Group mean scores for language, reading, and social adjustment were generally within an SD of normative samples of typically developing age-mates with normal hearing. Use of sign to enhance spoken communication negatively influenced verbal rehearsal speed, which was a strong predictor of all early outcomes, which in turn strongly influenced later outcomes. These analyses suggest that early communication mode exerts a powerful influence on early outcomes that persist into later years. Speech perception, speech intelligibility, language, literacy, and psychosocial adjustment far exceeded that reported for similar groups before the advent of CI technology.

Study question To determine the causal effect of in-vitro fertilisation (IVF) on primary school-age childhood developmental and educational outcomes, compared with outcomes following spontaneous conception. Summary answer The school-age developmental and educational outcomes for children conceived by IVF are equivalent to those of spontaneously conceived peers. What is known already More than 8 million children have been conceived globally with the assistance of in-vitro fertilization (IVF). Large cohort studies have suggested an increase in the frequency of congenital abnormalities, autism spectrum disorder, developmental-delay and intellectual disability in children conceived via IVF. Educational and cognitive outcomes following IVF conception have not yet been adequately established. Two large Scandinavian studies (Norrman et al 2018 and Wienecke et al 2020) found poorer educational outcomes in children born after IVF-conception. Study design, size, duration Causal inference methods (based on the potential outcomes approach) were used to analyse observation data in a way that emulates the results of a target randomised clinical trial. The study cohort comprised state-wide linked maternal and childhood administrative data from Victoria, Australia. Participants/materials, setting, methods The study included singleton infants conceived spontaneously or via IVF and born between 2005-2014. The exposure of interest was conception via IVF, with those born after spontaneous conception as the control group. Two separate measures of childhood outcome were examined: The Australian Early Developmental Consensus (AEDC), (age 4-6); and the National Assessment Program – Literacy and Numeracy (NAPLAN) at age 7-9. We combined inverse probability weighting with regression adjustment to estimate population average causal effects. Main results and the role of chance The final cohort included 412,713 children across the two outcome cohorts. Linked records were available for 4,697 IVF-conceived cases and 168,503 controls for AEDC outcome data, and 8,976 cases and 333,335 controls for NAPLAN data. The mothers of IVF-conceived children were older, more highly educated mothers, who lived in more socio-economic advantaged areas and were less likely to be from non-English speaking backgrounds. There was no causal effect of IVF-conception on the on the risk of developmental vulnerability at school-entry compared to spontaneously conceived children, as defined by AEDC metrics; with an adjusted risk difference of -0.3% (95% CI -3.7% to 3.1%) and an adjusted risk ratio of 0.97 (95% CI 0.77 to 1.25). At age 7-9 years, there was no causal effect of IVF-conception on the NAPLAN overall z-score, adjusted mean difference of 0.030 (95% CI -0.018 to 0.077) between IVF-conceived and spontaneously conceived children. Given the use of observational data, there were missing data and inherent differences in the covariate profile of the exposure cohorts. Multiple imputation and doubly robust inverse probability weighting regression adjustment modelling was utilised to allow a causal interpretation of results. Limitations, reasons for caution Children who did not attend school due to severe disability were not included, possibly leading to selection bias. It is possible that unmeasured common cause confounders could have led to bias in estimating the average treatment effects. Wider implications of the findings This study, in contrast to previous evidence, suggests that conception via IVF does not affect early childhood developmental and educational outcomes. These findings provide important reassurance for current and prospective parents, and clinicians alike. Trial registration number Not applicable

Cognitive Development Chart to Pediatric Care: Reliability and Utility of a Computerized Tool to Predict Multiple Outcomes in Children and Adolescents

This research sought to examine discriminatory and non-discriminatory practices influencing education and educational outcomes of children with disabilities in North Central geo-Political zone. The study adopted a survey research design. The sample included 400 teachers from the 2 select states through simple random sampling techniques to respond to the questionnaire and 20 children with disabilities through purposive sampling techniques interviewed. Mean and standard deviation ratings were used to answer the research questions, t-test and ANOVA statistics were used to test the hypotheses at 0.05 level of significance. Results showed that to enhance educational and educational outcomes of CWDs, all forms of discriminatory practices must be reduced to the barest minimum while inclusive education and all other forms of non-discriminatory practices must be enhanced to encourage CWDs education and performance; discriminatory practices hinders education, educational outcomes and performance of children with disabilities and non-discriminatory practices promotes education, educational outcomes and performance of CWDs. Some of the recommendations were: formulation of reasonable policies to promote CWDs education, with accompanying strategies for effective implementation of the policies; increase of funding for the erection of physical structures that address the plight of CWDs, provision of relevant resource materials that include professional teachers development, assistive learning and teaching aids; supply of necessary resources and facilities, including physical infrastructures like buildings, classrooms, trained educators, and supportive teaching technologies to meet the requirements of CWDs among others.

Disparities in Vision Health and Eye Care: Where Do We Go from Here?