Child-level Characteristics Research Articles

Individual and school correlates of body mass index and cardiorespiratory fitness in primary school children from the REACT project: A multivariate multilevel analysis.

This paper examines the relationship between body mass index (BMI) and cardiorespiratory fitness (CRF) using a multivariate multilevel approach and investigates the links between individual and school-related correlates with children's BMI and CRF. This cross-sectional sample included 1014 children (6-10 years) from 25 Portuguese primary schools. BMI was calculated, and CRF was assessed with the PACER test. Fundamental movement skills (FMS) included five object control tasks. Moderate-to-vigorous physical activity (MVPA), sleep, and sedentary time were assessed with the ActiGraph wGT3X-BT accelerometer. Socioeconomic status (SES) and school variables were also obtained. A multivariate multilevel model was used, and alpha was set at 5%. BMI and CRF systematically increased with age. Most of the joint variance (94.4%) was explained at the child level, and BMI and CRF were correlated at this level (ρ = -.37). More active children demonstrated higher CRF levels and had lower BMI levels; sedentary and sleep time were not significantly associated with BMI or CRF. FMS were positively associated with CRF but were not significantly associated with BMI. Children at higher SES were more fit and had lower BMI than their peers of lower SES. Finally, school-level variables were not significantly related to BMI and CRF. BMI and CRF had a low but statistically significant negative correlation in this sample of children. Most of the variation in BMI and CRF was explained by child-level characteristics.

Physical Activity and Motor Skill Development During Early Childhood: Investigating the Role of Parent Support.

This study examined the relationship between parent physical activity (PA) support and children's motor skill development and PA during early childhood and explored the potential moderating effect of child PA and motor skills on these relationships. Participants (N = 589, 250 girls, meanage = 4.93 [0.59]y) were part of a larger, longitudinal cohort study. Motor skills were assessed using the Movement Assessment Battery for Children-Second Edition. Moderate to vigorous PA (MVPA) was measured using ActiGraph accelerometers. Five items were used to measure parent support frequency (1 = none, 3 = 3-4 times, 5 = daily). Moderation analyses were conducted to examine the moderating effect of MVPA and motor skills on the relationship between parent support and motor skills and MVPA, respectively. Parent support was significantly related to motor skills (B = 14.45, P = .007), and child MVPA significantly moderated this relationship (B = -0.17, P = .021). The relationship between parent support and child MVPA did not reach significance (B = 2.89, P = .051); however, motor skills had a significant moderating effect (B = -0.08, P = .022). These novel findings suggest parent PA support is related to child motor skills and PA during early childhood, but this relationship is context dependent. Child-level characteristics should be considered in future parent PA support research.

The timing of executive function development is associated with growth in math achievement from preschool through second grade

We examined whether the timing of executive function (EF) development was associated with growth in children's math achievement across eight measurement occasions from preschool through second grade. Using a prospective longitudinal sample of 351 children, we found that children who developed EF later, entered preschool with the lowest levels of math performance and did not catch-up to their intermediate or early EF developing counterparts despite exhibiting a similar math growth rate through second grade. This trend was also observed after controlling for children's biological sex, early language skills, and socioeconomic background. These findings suggest that developing EF late might place children at a unique risk for math difficulties independent of important child and family level characteristics and can provide insights for instructional strategies that take into account differences in children's EF development.

Beyond personal factors: Multilevel determinants of childhood stunting in Indonesia.

Stunting is still a major public health problem in low- and middle-income countries, including Indonesia. Previous studies have reported the complexities associated with understanding the determinants of stunting. This study aimed to examine the household-, subdistrict- and province-level determinants of stunting in Indonesia using a multilevel hierarchical mixed effects model. We analyzed data for 8045 children taken from the 2007 and 2014 waves of the Indonesian Family and Life Surveys (IFLS). We included individual-, family-/household- and community-level variables in the analyses. A multilevel mixed effects model was employed to take into account the hierarchical structure of the data. Moreover, the model captured the effect of unobserved household-, subdistrict- and province-level characteristics on the probability of children being stunted. Our findings showed that the odds of childhood stunting vary significantly not only by individual child- and household-level characteristics but also by province- and subdistrict-level characteristics. Among the child-level covariates included in our model, dietary habits, neonatal weight, a history of infection, and sex significantly affected the risk of stunting. Household wealth status and parental education are significant household-level covariates associated with a higher risk of stunting. Finally, the risk of stunting is higher for children living in communities without access to water, sanitation and hygiene. Stunting is associated with not only child-level characteristics but also family- and community-level characteristics. Hence, interventions to reduce stunting should also take into account family and community characteristics to achieve effective outcomes.

The association of in-utero exposure to ambient fine particulate air pollution with low birth weight in India

A growing body of research indicates that in-utero exposure to ambient fine particulate matter (PM2.5) is a risk factor for low birth weight (LBW). However, research on India, where the high and rising level of ambient air pollution is a significant health concern, is limited. In this study, we analyze the association between ambient PM2.5 and LBW in India. We match data on birth weight from the National Family and Health Survey (NFHS) conducted in India in 2015–16 with high-resolution spatial data on annual ambient PM2.5 concentration to calculate in-utero exposure based on the residential location of each child. We estimate the association of in-utero exposure to ambient PM2.5 with birth weight and LBW, after adjusting for child level, maternal, and household level characteristics that predict birth weight. In our sample (n = 149 416), in comparison to the reference category of in-utero PM2.5 level less than 26.7 µg m−3, the adjusted OR of LBW increases non-linearly from 1.098 (95% CI: 0.954, 1.263) for children in the exposure band 39.3–44.7 µg m−3 (i.e., the fourth octile) to 1.241 (95% CI: 1.065, 1.447) for those in the exposure band 44.7–51.6 µg m−3 (i.e., the fifth octile) and 1.405 (95% CI: 1.126,1.753) for those with in-utero PM2.5 level greater than 77.3 µg m−3 (i.e., the last octile). Our findings show that exposure to ambient PM2.5 is strongly associated with LBW in India and suggest that policies that improve air quality may be necessary for achieving the World Health Assembly target of 30% reduction in LBW by 2025.

School characteristics and children's mental health: A linked survey-administrative data study

Mental health difficulties are childhood-onset with lifelong health, social and economic consequences. Children spend a large amount of time in schools, making schools an important context for mental health prevention and support. We examine how school composition and school climate, controlling for individual child-level characteristics, are associated with children's mental health difficulties (emotional and behavioural difficulties). Data from 23,215 children from 648 primary schools in England were analysed to examine the associations of school composition (size, gender, socioeconomic and ethnicity) and school climate with mental health (emotional symptoms, behavioural symptoms and above clinical cut-off scores) adjusting for individual child socio-demographic characteristics. We find that between 3% and 4.5% of the variation in children's mental health outcomes could be attributed to schools. Of this, small proportions were explained by school composition (1.4 to 3.8%) and larger proportions were explained by school climate (29.5 to 48.8%). Lower school socio-economic status was associated with higher behavioural symptoms (coef = 0.02 [95%CI: 0.01–0.04]) and slightly raised odds of high mental health difficulties (OR = 1.05, 95% CI: 1.01,1.09). More positive school climate was associated with lower emotional (coef = −0.09 [95%CI:-0.11,-0.08]) and behavioural (coef = −0.13 [95% CI,-0.15:-0.11]) symptoms and lower odds of mental health difficulties (OR = 0.78, 95%CI:0.74,0.81). Some associations between school factors and mental health were moderated by child sex and SES. School composition factors were weakly associated with children's mental health, whereas school climate explained a larger amount of between-school variation and appears a good target for universal prevention of mental health difficulties in children.

Individual differences in the influence of taste and health impact successful dietary self-control: A mouse tracking food choice study in children

In order to improve dietary quality among children, there is a need to understand how they make decisions about what foods to eat. This study used a mouse tracking food choice task to better understand how attributes such as health and taste contribute to food decisions among 70 children aged 7-to-11 years old. Children rated health, taste, and desire to eat for 76 common foods that varied in energy density and then used a computer mouse to select which of two presented foods they would like to eat. The presented food pairs were based on children's own ratings of taste and health so that some trials required self-control to choose the healthier option (i.e., healthy/not tasty paired with unhealthy/tasty). Children's body mass index (BMI) percentile was not associated with number of healthy choices. To examine mouse trajectories, we replicated previous analytic techniques and applied a novel technique, time-varying effects modeling (TVEM). Results showed that desire to eat impacted food decision-making sooner than taste and health during trials that required self-control, with TVEM showing that early discounting of desire to eat enabled healthier choices. However, these temporal dynamics varied by age, BMI percentile, and overall self-control performance in the task. When the less healthy food was chosen (i.e., self-control failure), older children and children with better overall self-control were more influenced by taste and desire to eat. However, children with higher BMI percentiles showed stronger discounting (i.e., negative influence) of taste when choosing the healthier food. Together this highlights how the influence of hedonic food attributes on food decision-making varies by individual child-level characteristics. Understanding individual differences in the cognitive processes that support healthy food choices in children may help identify targets for interventions aimed at improving child nutrition

Parents’ experiences of the service pathway to an autism diagnosis for their child: What predicts an early diagnosis in Australia?

BackgroundThe early identification and diagnosis of autism is critical to ensure access to appropriate early intervention and support. Few studies have examined the association between potentially modifiable characteristics of the service system and timelier diagnosis. MethodsAn online survey was conducted to examine parental experiences of service pathways to an autism diagnosis for their child, and to identify child, family, and service level characteristics that predict the age and timeliness of diagnosis. Participants included 107 parents of children with autism who were diagnosed by 7 years of age and a smaller subgroup of 29 parents who were diagnosed after 7 years of age. ResultsParents of younger children reported that, on average, it took approximately 12 months and 8 professional consultations to receive a confirmed diagnosis for their child. Parents of older children, as well as those who reported they were a sole caregiver, or were advised by professionals to ‘wait and see’, reported more time between first raising concerns and diagnosis. ConclusionsThe findings reiterate the importance of proactive professional responses to parental concerns. They also highlight the need for standardised screening and assessment and professional development and training to build capacity in the sector to deliver timely and accurate autism diagnoses.

Precarious Childhoods: Childhood Family Income Volatility and Mental Health in Early Adulthood

AbstractThe rise of income volatility in western countries has been extensively documented in the literature, but empirical research has just started to examine how childhood exposure to family income volatility affects subsequent wellbeing. This study takes advantage of several nation-wide, population registers from Sweden with linkages within and across generations to examine the intergenerational impact of childhood family income volatility on psychiatric disorders in early adulthood. In addition to the population-average effects, we also examine the heterogeneity in the impact of family income volatility for families at the top, bottom, and middle of the family income distribution. Our results suggest that after controlling for a set of family- and child-level characteristics, childhood family income volatility has a negative effect on mental wellbeing, and this finding is consistent across a range of psychiatric outcomes. Furthermore, we show that while children from low-income families exhibit the greatest likelihood of psychiatric disorder, children from families in the middle of the income distribution experience the greatest negative impact of income volatility.

Individual-level predictors of practices of nutrition-specific and nutrition-sensitive interventions for infants and young children in West and Central Africa: a cross-sectional study

ObjectivesTo explore the role of individual-level and household-level characteristics for practice of nutrition-specific and nutrition-sensitive interventions.DesignSecondary data analysis (cross-sectional).SettingWest and Central Africa.ParticipantsData are from the Demographic and Health Surveys in...

District Effect Appraisal in East Sub-Saharan Africa: Combating Childhood Anaemia.

Background Anaemia in children is a significant health problem that receives little attention. This study aimed at determining the factors significantly associated with anaemia in children aged 6 to 59 months in Kenya, Malawi, Tanzania, and Uganda while accounting for the spatial heterogeneity within and between the districts of the four countries. In addition, the performance of the districts with regard to their impact on anaemia was assessed and ranked. Methods A generalised additive mixed model with a spatial effect based on the geographical coordinates of the clusters was used. A district-level random effect was included to further account for the heterogeneity as well as to rank the performance of the districts based on the best linear unbiased prediction (BLUP). Results The results depicted significant spatial heterogeneity between and within the districts of the countries. After accounting for such spatial heterogeneity, child-level characteristics (gender, malaria test result, and mother's highest education level), household-level characteristics (household size, household's wealth index Z-score, the type of toilet facility available, and the type of place of residence), and the country of residence were found to be significantly associated with the child's anaemia status. There was a significant interaction between the type of place of residence and the country of residence. Based on the BLUP for the district-level random effect, the top 3 best- and worst-performing districts within each country were identified. Conclusion The ranking of the performance of the districts allows for the worst-performing districts to be targeted for further research in order to improve their anaemia control strategies, as well as for the best-performing districts to be identified to further determine why they are performing better and then to use these districts as role models in efforts to overcome childhood anaemia.

Correlates of Overweight in Children and Adolescents Living at Different Altitudes: The Peruvian Health and Optimist Growth Study.

Background and Aim Overweight prevalence in children and adolescents shows great variability which is related to individual-level and environmental-level factors. The present study aimed to determine the prevalence of and factors associated with overweight in Peruvian children and adolescents living at different altitudes. Methods 8568 subjects, aged 6–16 y, from the sea level, Amazon, and high-altitude regions were sampled. Overweight was identified using BMI; biological maturation and physical fitness were measured; school characteristics were assessed via an objective audit. Results Overweight prevalence decreased with age (28.3% at 6 y to 13.9% at 16 y); it was higher in girls (21.7%) than boys (19.8%) and was higher at the sea level (41.3%), compared with Amazon (18.8%) and high-altitude (6.3%) regions. Approximately 79% of the variance in overweight was explained by child-level characteristics. In Model 1, all child-level predictors were significant (p < 0.001); in Model 2, six out of nine added school-level predictors (number of students, existence of policies and practices for physical activity, multisports-roofed, duration of Physical Education classes, and extracurricular activities) were significant (p < 0.001); in Model 3, subjects living at high altitudes were less likely to be overweight than those living at the sea level. Conclusions Child- and school-level variables played important roles in explaining overweight variation. This information should be taken into account when designing more efficient strategies to combat the overweight and obesity epidemic.

Higher child-raising costs due to maternal social isolation: Large population-based study in Japan

BackgroundTo assess the association between maternal social isolation and the child-rearing costs among mothers with 6-month-old infants. MethodsData was analyzed from a population-based birth-cohort study in Japan, the Longitudinal Survey of Babies in the 21st Century (n = 40,643). Maternal isolation was defined by lack of social support among mothers expressing difficulties with child rearing. Child-rearing costs for one month (when the infant was 6-months-old) were self-reported in units of JPY 10,000 (approximately 80 USD). The association between maternal social isolation and child-rearing cost was assessed using generalized linear models adjusted for child, maternal, and family level characteristics. ResultsOf the sample, 258 (0.6%) women were classified as socially isolated. In the crude model, isolated mothers paid JPY 6980 (95% confidence interval [CI]: 4753–9207), approximately USD$87, more per month on child-rearing expenses compared to non-isolated mothers. This finding was similar in the multivariable adjusted model (marginal effect: JPY 4,186, 95% CI, 2235–6136). Stratified analysis comparing low income vs. non-low income mothers showed that, among the former group, socially isolated mothers spend more on child rearing than mothers who are not isolated (marginal effect: JPY 13,218, 95% CI:784 to 2565), while among the non-low income group, a significant association was not observed. ConclusionsSocially isolated mothers spent JPY4,186 (approximately USD 35) more per month on child-rearing costs compared to non-isolated mothers when the infant was aged 6 months old. In nationwide terms, this cost could be roughly calculated as JPY 350 million (approximately USD 2.9 million) in 2001. Provision of social network connections and support for socially isolated mothers is suggested to be an efficient public health policy.

Examining Dietary Change as a Determinant of Improving Child Nutritional Status in Bangladesh from 1992 to 2005 (OR10-07-19)

ObjectivesWe sought to quantify the impact of the transition in household diets in Bangladesh on the reduction of stunting in children from six months to two years of age over the 13-year period from 1992 to 2005. MethodsThis study utilizes data from four rounds of two linked survey systems: the Bangladesh Household [Income and] Expenditure Surveys (H[I]ES) and the Child [and Mother] Nutrition survey (C[M]NS). The households included in the C[M]NS were a subsample of those contained in the H[I]ES. Across all years, we analyzed 3484 children who were six to twenty-three months of age at the time of C[M]NS. Dietary change was measured through dietary patterns previously derived using principal component analysis. We used Blinder-Oaxaca decomposition to assess the impact of changing diets, other socioeconomic characteristics of households, and child level characteristics on child nutritional status over time. ResultsFor six dietary patterns, the prevalence of adherence changed over time. In a fully adjusted model, only the “modern” dietary pattern – characterized by processed soybean/palm oil, poultry and beef, beverages, generally more diversity, and less rice – was significantly associated with changes in child nutritional status. Indicators included in the decomposition models explained 64% of the observed change in length-for-age z-score (LAZ), 84% of the observed change in weight-for-age z-score (WAZ), and 180% of the observed change in weight-for-length z-scores (WFL). The dietary transition towards the “modern” diet over time was a significant predictor of better child LAZ and WAZ, but not quite significant for WFL (p-values: 0.005, 0.005, and 0.07, respectively). Other significant predictors of LAZ and WAZ included changes in household access to improved latrines and increased caregiver education. Increased household real income was not a significant predictor of improved nutritional status. ConclusionsChanges in household characteristics, namely more diverse diets and improved latrines, along with increasing caregiver education, were able to largely explain the changes in child nutritional status over time. Increasing income, however, did not independently improve child growth. This points to the need to focus on nutrition-specific and -sensitive interventions to continue to decrease child malnutrition. Funding SourcesThis publication has been produced with the assistance of the European Union and the UK Department for International Development. The contents of this publication are the sole responsibility of its authors and do not necessarily reflect the views of the European Union or the UK Department for International Development. Supporting Tables, Images and/or Graphs▪▪

Maternal autonomy and birth registration in India: Who gets counted?

This paper examines the effect of maternal socio-economic status in the household, such as their autonomy, ability, freedom and bargaining power, on child birth registration in India using the nationally representative India Human Development Survey-II (IHDS-II), 2011–12. We have estimated a multilevel mixed effects model which accounts for the hierarchical structure of the data and allows us to examine the effects of unobserved ‘district’ and ‘community’ characteristics along with individual child level characteristics on probability of birth registration. The results show that between-districts and between individuals differences share a considerably high and an almost equal proportion of the variations in probability of birth registration in India. At individual child level, mother’s socio-economic status such as her ability to move around independently and her exposure to outside world, significantly raise the probability of birth registration. More importantly, the marginal effects of the maternal autonomy indicators: mother’s ability to move around freely and her control over resources, on birth registration vary across districts in India. Other variables such as institutional birth, mother’s antenatal care seeking behaviour, caste, religion, household wealth and parental education are significant determinants of birth registration.

Gender Differences in Mathematics Performance: Evidence from Rural India

Gender has been among the most pervasive forms of inequality across all classes, social groups and communities especially in developing countries. Literature indicates evident gender bias in labor market opportunities including wage gap, which can be partially explained by performance in mathematics. In this context, using nationally representative data from 2011-12, this paper examines gender gap in performance in mathematics among rural children at an all-India level. Our findings from the regressions show significant gender gap in mathematics, controlling for various child, household, school or region level characteristics. This is not largely found to be observable for reading skills or writing skills. We also find the results remaining consistent across various types of households both in terms of financial conditions and demographic composition, social groups, children of different birth orders and even across the type of schools they attend. While exploring the possible reasons behind the gender gap, we fail to find the significance of innate ability. However we find indicative evidences of: worse health outcomes for girls in early childhood, possible higher participation of boys in petty works outside home or in sports, and economic aspirations along with gender role stereotyping emanating from family and society as (one or multiple) possible explanations. The policy recommendations include research in form of systematic evaluations to identify the instruments including the psychological interventions which can help in reducing the gender gap in mathematics. This is especially necessary in states including Uttar Pradesh, Tamil Nadu and Gujarat among others that do not show significant improvement in performance of girls with respect to boys over the years.

Predictors of Language Gains Among School-Age Children With Language Impairment in the Public Schools.

This study aimed to identify child-level characteristics that predict gains in language skills for children with language impairment who were receiving therapy within the public schools. The therapy provided represented business-as-usual speech/language treatment provided by speech-language pathologists in the public schools. The sample included 272 kindergartners and first-graders with language impairment who participated in a larger study titled "Speech-Therapy Experiences in the Public Schools." Multilevel regression analyses were applied to examine the extent to which select child-level characteristics, including age, nonverbal cognition, memory, phonological awareness, vocabulary, behavior problems, and self-regulation, predicted children's language gains over an academic year. Pratt indices were computed to establish the relative importance of the predictors of interest. Phonological awareness and vocabulary skill related to greater gains in language skills, and together they accounted for nearly 70% of the explained variance, or 10% of total variance at child level. Externalizing behavior, nonverbal cognition, and age were also potentially important predictors of language gains. This study significantly advances our understanding of the characteristics of children that may contribute to their language gains while receiving therapy in the public schools. Researchers can explore how these characteristics may serve to moderate treatment outcomes, whereas clinicians can assess how these characteristics may factor into understanding treatment responses.

Modeling Polymorphemic Word Recognition

Comprehensive models of derived polymorphemic word recognition skill in developing readers, with an emphasis on children with reading difficulty (RD), have not been developed. The purpose of the present study was to model individual differences in polymorphemic word recognition ability at the item level among 5th-grade children (N = 173) oversampled for children with RD using item-response crossed random-effects models. We distinguish between two subtypes of RD children with word recognition problems, those with early-emerging RD and late-emerging RD. An extensive set of predictors representing item-specific knowledge, child-level characteristics, and word-level characteristics were used to predict item-level variance in polymorphemic word recognition. Results indicate that item-specific root word recognition and word familiarity; child-level RD status, morphological awareness, and orthographic choice; word-level frequency and root word family size; and the interactions between morphological awareness and RD status and root word recognition and root transparency predicted individual differences in polymorphemic word recognition item performance. Results are interpreted within a multisource individual difference model of polymorphemic word recognition skill spanning item-specific, child-level, and word-level knowledge.

The relationship between parents' poor emotional health status and childhood mood and anxiety disorder in Florida children, national survey of children's health, 2011-2012.

The purpose of this study was to examine how parents' emotional health relates to childhood mood and anxiety disorder among Florida children in the 2011-2012 National Survey of Children's Health. Analyses were restricted to 1,241 Florida children 6-17 years of age. Childhood mood and anxiety disorder was defined as a parent-reported diagnosis of current depression or anxiety. Parents' emotional health status was a composite measure of the lowest reported emotional health of any parent in the household. To assess the association between parents' emotional health and childhood mood and anxiety disorder, bivariate and multivariate logistic regression analyses were performed. Nearly 5 % of Florida children had a mood or anxiety disorder in 2011-2012. Children living with a parent in poor emotional health were significantly more likely to have a mood or anxiety disorder compared to children living with a parent in good emotional health (OR 5.01; 95 % CI 1.89, 13.29). After adjusting for covariates, this association remained substantial and significant (aOR 4.33; 95 % CI 1.49, 12.57). Findings presented here are consistent with national findings and emphasize the strong link between parents' emotional health status and childhood mood and anxiety disorders. To address the mental health of children in the state of Florida, Florida public health initiatives should consider family processes and child level characteristics.

To tell or not to tell: what influences children's decisions to report bullying to their teachers?

Teachers are the primary agents for creating and maintaining a positive classroom climate--and promoting healthy interpersonal relations with, and among, their students (including the prevention of school bullying) is key to achieving this goal. For this study it was posited that students' willingness to report bullying to their teachers is an indicator of the degree to which teachers have successfully created such environments. Data were gathered on 278 (135 boys; 152 girls) ethnically diverse (46.4% Hispanic; 43.5% White; 10.2% Black and Other) 8- to-10-year-old students. Results showed that classrooms in which children reported greater willingness to report bullying evidenced lower levels of victimization. Moreover, believing that teachers would take an active role in intervening, such as by separating involved students or involving parents and principals, was associated with greater willingness to report than child-level characteristics, such as grade, personal blame, and individuals' propensity toward aggression.