Disadvantaged Families Research Articles

Editorial Introduction

The two case studies of Part IV are based on interviews with poor, disadvantaged families in Lahore (Pakistan) and Cincinnati (United States). These analyses in the sociocultural and welfare dimension address the subjective experiences of how the lockdowns resulting from COVID-19 impacted the quality of the circumstances of their daily lives. The analyses of Part III primarily also were oriented around the sociocultural and welfare dimension. They, among others, regarded the impact of the pandemic on community resilience and agency in the United Kingdom and Germany to sustain supportive networks in their respective “civil societies.” By also exploring political “civic activism” and the impact on “democratic resilience,” the observations and discussions here though have become primarily focused on the sociopolitical and legal dimension.

Erken Çocukluk Dönemindeki Sığınmacı ve Türk Asıllı Çocukların Okula Uyum Sürecinin Analizi

Suriye'de yaşanan iç savaşın uzaması ve memleketini terk edip gelen sığınmacıların ülkelerine geri dönememelerinden dolayı bir çok çocuk farklı ülkelerde ve kademelerde okula gitmeye başlamıştır. Sığınmacı çocukların acil olarak karşılanması gereken ihtiyaçlarının başında da eğitim ihtiyacı gelmektedir. Bu araştırma, erken çocukluk döneminde okul öncesi eğitimi alan, sığınmacı ve Türk asıllı çocukların okula uyum sorunlarını belirlemek amacıyla yürütülmüştür. Çocukların dil engeli ve yaşadıkları travmanın okula uyumlarına etkisinin incelendiği bu çalışmada çocuk gözlemleri, ebeveyn ve eğitmen görüşleri alınmak suretiyle nitel araştırma modellerinden Durum Araştırması uygulanmıştır. Araştırmanın çalışma grubunu, Çanakkale Onsekiz Mart Üniversitesi ÇABA Çok Amaçlı Erken Çocukluk Eğitimi Merkezi’nde (ÇABAÇAM) kayıtlı 4 sığınmacı çocuk ve özellikle gelişimsel olarak dezavantajlı ailelerden gelen 4 Türk asıllı çocuk, ebeveynleri ve 11 eğitmen oluşturmaktadır. Katılımcılar amaçlı örnekleme yöntemlerinden Ölçüt Örneklemesi olarak nitelendirilen örneklem türü kullanılarak belirlenmiş, verilerin analizinde betimsel analiz yöntemi kullanılmıştır. Araştırmanın sonucunda sığınmacı çocukların okula uyumunu etkileyen en önemli faktörün dil sorunu olduğu görülmüştür.

Out of pocket costs and time/productivity losses for pediatric sepsis in Uganda: a mixed-methods study

BackgroundSepsis disproportionately affects children from socioeconomically disadvantaged families in low-resource settings, where care seeking may consume scarce family resources and lead to financial hardships. Those financial hardships may, in turn, contribute to late presentation or failure to seek care and result in high mortality during hospitalization and during the post discharge period, a period of increasingly recognized vulnerability. The purpose of this study is to explore the out-of-pocket costs related to sepsis hospitalizations and post-discharge care among children admitted with sepsis in Uganda.MethodsThis mixed-methods study was comprised of focus group discussions (FGD) with caregivers of children admitted for sepsis, which then informed a quantitative cross-sectional household survey to measure out-of-pocket costs of sepsis care both during initial admission and during the post-discharge period. All participants were families of children enrolled in a concurrent sepsis study.ResultsThree FGD with mothers (n = 20) and one FGD with fathers (n = 7) were conducted. Three primary themes that emerged included (1) financial losses, (2) time and productivity losses and (3) coping with costs. A subsequently developed cross-sectional survey was completed for 153 households of children discharged following admission for sepsis. The survey revealed a high cost of care for families attending both private and public facilities, although out-of-pocket cost were higher at private facilities. Half of those surveyed reported loss of income during hospitalization and a third sold household assets, most often livestock, to cover costs. Total mean out-of-pocket costs of hospital care and post-discharge care were 124.50 USD and 44.60 USD respectively for those seeking initial care at private facilities and 62.10 USD and 14.60 USD at public facilities, a high sum in a country with widespread poverty.ConclusionsThis study reveals that families incur a substantial economic burden in accessing care for children with sepsis.

“I thought, Oh shit, because I was 19.” Discourses and practices on young fatherhood in Denmark

This article presents the voices of 30 young fathers from the first interview-based study in Denmark on young fatherhood. The findings show that men face significant challenges when they become fathers at a young age and that they often feel stigmatised by society. Young fatherhood, however, can also promote social integration and produce forms of empowerment. Unlike most international research on young fatherhood, this study shows that economic circumstances do not play a crucial role in the ability of fathers to gain access to their children. This may be due to support aimed at socially disadvantaged families provided by the state. The results further indicate that early fatherhood should be seen as a transitional process, rather than as an event, with the young father gradually abandoning teenage life and where a delay in the development of the father-child relationship does not necessarily rule out the later emergence of a stable father-child relationship.

Physical Activity Spaces Not Effective against Socioeconomic Inequalities in Myopia Incidence: The Generation R Study.

Our findings show that non-Dutch background, lower maternal education, and lower net household income level may be new risk factors for myopia development in the Netherlands. Newly introduced physical activity spaces may not be effective enough in increasing outdoor exposure in children to reduce eye growth. The aims of this study were to evaluate socioeconomic inequalities in myopia incidence, eye growth, outdoor exposure, and computer use and to investigate if newly introduced physical activity spaces can reduce eye growth in school-aged children. Participants (N = 2643) from the Dutch population-based birth cohort Generation R were examined at ages 6 and 9 years. Socioeconomic inequalities in myopia incidence, eye growth, and lifestyle were determined using regression analyses. Information on physical activity spaces located in Rotterdam was obtained. Differences in eye growth between those who became exposed to new physical activity spaces (n = 230) and those nonexposed (n = 1866) were evaluated with individual-level fixed-effects models. Myopia prevalence was 2.2% at age 6 years and 12.2% at age 9 years. Outdoor exposure was 11.4 h/wk at age 6 years and 7.4 h/wk at age 9 years. Computer use was 2.1 h/wk at age 6 years and 5.2 h/wk at age 9 years. Myopia incidence was higher in children with non-Dutch background, and families with lower household income and lower maternal education (odds ratio [OR], 1.081 [95% confidence interval, 1.052 to 1.112]; OR, 1.035 [95% confidence interval, 1.008 to 1.063]; OR, 1.028 [95% confidence interval, 1.001 to 1.055], respectively). Children living <600 m of a physical activity space did not have increased outdoor exposure, except those from families with lower maternal education (β = 1.33 h/wk; 95% confidence interval, 0.15 to 2.51 h/wk). Newly introduced physical activity spaces were not associated with reduction of eye growth. Children from socioeconomically disadvantaged families became more often myopic than those from socioeconomically advantaged families. We did not find evidence that physical activity spaces protect against myopia for the population at large, but subgroups may benefit.

Pregnancy and Infant Development (PRIDE)\u2014a preliminary observational study of maternal adversity and infant development

BackgroundChildren from socioeconomically disadvantaged families have a markedly elevated risk for impaired cognitive and social-emotional development. Children in poverty experience have a high risk for developmental delays. Poverty engenders disproportionate exposure to psychological adversity which may contribute to impaired offspring development; however the effect may be mitigated by social support and other aspects of resilience. Our objective was to determine the association between maternal stress, adversity and social support and early infant neurobehavior and child behavior at two and three years.MethodsWe conducted a longitudinal mother-infant cohort study nested within a regional home visiting program in Cincinnati, Ohio. Four home study visits were completed to collect measures of maternal stress, adversity and social support and infant and child behavior. A measure of infant neurobehavior (‘high-arousal’ infant) was derived from the NICU Network Neurobehavioral Scale (NNNS) at 1 month and externalizing and internalizing symptoms were measured by the Child Behavior Checklist (CBCL) at 24 and 36 months. Linear and logistic regression identified associations between maternal risk/protective factors and infant and child behavioral measures. We used stratification and multiplicative interaction terms to examine potential interactions.ResultsWe enrolled n = 55 pregnant mothers and follow 53 mother–offspring dyads at 1 month, 40 dyads at 24 months and 27 dyads at 36 months. Maternal adversity and protective factors were not associated with neurobehavior at one month. However, maternal depression and measures of distress in pregnancy were significantly associated with internalizing and externalizing symptoms at 24 and 36 months.ConclusionsThis pilot study established the feasibility of conducting longitudinal research within a community intervention program. In addition, although there were no statistically significant associations between maternal psychosocial factors in pregnancy and infant neurobehavior, there were several associations at 24 months, primarily internalizing symptoms, which persisted through 36 months. Future work will replicate findings within a larger study as well as explore mediators and modifiers of these associations.

Socioeconomic position and prediagnostic health care contacts in children with cancer in Denmark: a nationwide register study

BackgroundWhile underlying mechanisms and pathways of social inequalities in cancer survival have been extensively examined in adults, this is less so for children with cancer. Hypothesized mechanisms include prediagnostic utilization of and navigation through the health care system, which may differ by socioeconomic resources of the families. In this nationwide register-based study we investigated the association between measures of family socioeconomic position in relation to prediagnostic health care contacts and stage of disease at diagnosis in children with cancer in Denmark.MethodsWe identified all children diagnosed with a cancer at ages 0–15 years in 1998–2016 (N = 3043) from the Danish Childhood Cancer Registry. We obtained comprehensive information on measures of socioeconomic position, parental health and prediagnostic contacts to both general practitioners and hospitals 24 months prior to diagnosis from various national registries. We fitted multivariable conditional logistic regression models for the association of family socioeconomic and health-related variables with firstly, frequent health care contacts and secondly, advanced stage.ResultsWe found higher odds ratios (OR) of frequent both overall and emergency health care contacts in the last 3 months before diagnosis in children from households with short parental education and mixed affiliation to work market, when compared to children with high family socioeconomic position. Further, children of parents with depression or of non-Western origin, respectively, had higher OR for frequent overall and emergency contacts. We found no association between socioeconomic position, parental health and stage of disease.ConclusionFamilies with socioeconomic disadvantage, non-Western origin or depression more frequently utilize prediagnostic health care services, both generally and in the acute setting, indicating that some disadvantaged families may struggle to navigate the health care system when their child is sick. Reassuringly, this was not reflected in disparities in stage at diagnosis. In order to improve the diagnostic process and potentially reduce health care contacts, attention and support should be given to families with a high number of health care contacts over a short period of time.

The child perspective within family intervention projects: a cluster-randomised study with a mixed methods design

ABSTRACT Family interventions have been introduced in several European countries as social inclusion measures for disadvantaged families. Compared with adult social work, in social work for families, social workers aim to utilise a whole-family approach; they follow up all family members, acknowledge multiple target areas and coordinate the services for the families. This cluster-randomised study (ClinicalTrials.gov: NCT03102775) with a mixed methods approach analyses children’s involvement in family interventions and compares child-related effects of governmental (the HOLF model) and local family intervention practices in Norway. The data are based on a cluster-randomised study involving 29 Labour and Welfare offices and baseline and follow-up questionnaires for parents (N = 862). We conducted in-depth interviews with family coordinators to help us understand how children are involved and how their involvement may contribute to any improvements. While there were no effects of using the HOLF model compared with local family intervention practices, results indicate that the family intervention seems to contribute to increasing children’s involvement with welfare services and improving their access to welfare support. The interviews demonstrate the potential of a genuine whole-family approach, where children are directly involved in the family intervention practices. Trial registration: ClinicalTrials.gov identifier: NCT03102775

Childhood health and social class reproduction in China

In previous studies on social stratification and mobility in China, education is considered as the core mediatory factor in social reproduction and mobility. This paper, however, investigates how childhood health affects social stratification. Using data from Urbanization and Labor Migrant National Survey (2012), this study examines the effects of nutrition, hygiene, and health before age 14 on adult socioeconomic status attainment, including education, the international socioeconomic indexes of first job and current job, and family income per head. The structural equation model results show that the nutrition intake (whether one experienced starvation and the frequency of fish and meat intake) and hygiene (indicated by the source of drinking water and the toilet type) have significant effect on adult socioeconomic status attainment. However, the effects change at different life course stages. Moreover, childhood health (indicated by adult height) has significant impact on adult socioeconomic status attainment, but no significant impact on the international socioeconomic indexes of first job and current job. We conclude that investment in childhood health is an important mechanism affecting social class reproduction and mobility. Therefore, health intervention for children from poor and disadvantaged families are necessary. It will benefit children’s education and encourage upward mobility.

Child Health and Parental Responses to an Unconditional Cash Transfer at Birth

We estimate the impact on child health of the unanticipated introduction of the Australian Baby Bonus, a $3,000 one-off unconditional cash transfer at birth. Using regression discontinuity methods and linked administrative data from South Australia, we find that treated babies had fewer preventable, acute, and urgent hospital presentations—medical care available without co-payments—in the first two years of life. The payment later increased demand for elective care, which requires planning, medical referrals, and often co-payments. Our effects are strongest for disadvantaged families. Our findings suggest that up to 34% of the payout were recouped within the first year.

The Consumption, Income, and Well-Being of Single mother–headed Families 25 Years After Welfare Reform

We investigate how material well-being has changed over time for single mother headed families—the primary group affected by welfare reform and other policy changes of the 1990s. We focus on consumption as well as other indicators including components of consumption, measures of housing quality, and health insurance coverage. The results provide strong evidence that the material circumstances of single mothers improved in the decades following welfare reform. The consumption of the most disadvantaged single mother headed families—those with low consumption or low education—rose noticeably over time and at a faster rate than for those in comparison groups.

Parental Vaccine Hesitancy and Risk of Pediatric Influenza Under-Vaccination in a Safety-Net Health Care System.

To measure the risk of influenza under-vaccination in children of vaccine-hesitant parents, referent to children of nonhesitant parents, in a sample of disadvantaged families in one influenza season. A prospective observational cohort study of English- and Spanish-speaking parents of 2-year-olds presenting at random for well, sick, or specialty visit care from August 1, 2019 to February 28, 2020. Parents answered demographic questions and the Parent Attitudes about Childhood Vaccines survey. We followed children until season's end, extracting vaccination data on April 30, 2020. We dichotomized vaccination status as unvaccinated or partially/fully vaccinated, analyzing data with multivariable Poisson regression; in secondary analyses, we conducted adjusted time-to-event analyses. Overall, 263 parents consented (response rate: 90%); our final sample included 255 dyads. Thirty-three (13%) parents were vaccine hesitant. In adjusted analyses, children of hesitant parents (n=33) had a 195% increased risk (adjusted Risk Ratio 2.95; 95% confidence interval 1.91, 4.56) of being unvaccinated at season's end, referent to children of nonhesitant parents (n=222). In time-to-event analyses, children of vaccine-hesitant parents were also more likely to be unvaccinated before influenza activity peaked (P=.02). Parental vaccine hesitancy tripled the risk of pediatric influenza nonvaccination in a sample of poor and minority families during the 2019 to 2020 influenza season. As parental vaccine hesitancy appears to exacerbate pediatric influenza vaccination disparities, future work should explore parental hesitancy with poor and minority stakeholders and tailor evidence-based interventions to benefit children from these communities who receive care at all practice sites.

“Some days it’s like she has died.” A qualitative exploration of first mothers’ utilisation of artefacts associated with now-adopted children in coping with grief and loss

In this article, I take a critical approach to the marginalisation of the grief experienced by first mothers who have experienced the non-consensual adoption of a child in England, in a context within which welfare benefits and services intended to support the most disadvantaged families have been dramatically curtailed. With reference to the concepts of disenfranchised grief and ambiguous loss, and in light of some identified parallels between the death of a child and the loss of a child to adoption, I draw upon literature from the field of bereavement studies in presenting findings arising from semi-structured interviews in which 17 first mothers sorted through artefacts such as toys, clothing and blankets associated with their now-adopted children and reflected upon the meanings that such keepsakes had taken on in their lives after loss. Respondents’ accounts revealed that artefacts were invested with high value, and could operate as vehicles for memories of time spent caring for children. It was found that interacting with artefacts could bring comfort, evoking in mothers sensory memories of the smell and feel of their now-adopted child. Interactions with artefacts were found to hold capacity to affirm respondents’ maternal status, as well as symbolising oppression and injustice, sometimes evoking strong feelings of anger directed towards professionals involved in children’s adoption.

The Impact of High School Entrance Examination Competition on Students’ Participation in Extracurricular Tutoring in the Compulsory Education Period: An Empirical Analysis Based on the Data of China Family Panel Studies

We used the Hierarchical Linear Bernoulli Model based on China Family Panel Studies (CFPS) 2016 data and provincial high school acceptance rate data. We explored the relationship between provincial high school entrance examination competition and students’ extracurricular tutoring participation during compulsory education. The study found that the high school acceptance rate and occupational high school acceptance rate have no significant effect on the participation rate of students’ extracurricular tutoring in the compulsory education stage. However, the high school acceptance rate has a significant positive impact on the participation rate of students’ extracurricular tutoring, and there is a heterogeneous effect on the participation rate of students’ extracurricular tutoring from families of different social classes. The higher the high school acceptance rate, the greater the probability of students from families with higher social strata participating in extracurricular tutoring. The demonstration high school acceptance rate has a significant negative impact on students’ extracurricular tutoring participation rate. It has a heterogeneous influence on students’ extracurricular tutoring participation in different school stages and social class families. The education administration department should actively expand high-quality, high school educational resources and increase the demonstration high school acceptance rate. And to increase the number of admissions for the demonstration high school to disadvantaged families with lower social strata to alleviate the pressure of families and students from the high school entrance examination competition. This can not only reduce the participation rate of students’ extracurricular tutoring during the compulsory education stage, but also promote the equalization of high-quality high school entrance opportunities for children of different classes of families.

The Impact of High School Entrance Examination Competition on Students’ Participation in Extracurricular Tutoring in the Compulsory Education Period: An Empirical Analysis Based on the Data of China Family Panel Studies

We used the Hierarchical Linear Bernoulli Model based on China Family Panel Studies (CFPS) 2016 data and provincial high school acceptance rate data. We explored the relationship between provincial high school entrance examination competition and students’ extracurricular tutoring participation during compulsory education. The study found that the high school acceptance rate and occupational high school acceptance rate have no significant effect on the participation rate of students’ extracurricular tutoring in the compulsory education stage. However, the high school acceptance rate has a significant positive impact on the participation rate of students’ extracurricular tutoring, and there is a heterogeneous effect on the participation rate of students’ extracurricular tutoring from families of different social classes. The higher the high school acceptance rate, the greater the probability of students from families with higher social strata participating in extracurricular tutoring. The demonstration high school acceptance rate has a significant negative impact on students’ extracurricular tutoring participation rate. It has a heterogeneous influence on students’ extracurricular tutoring participation in different school stages and social class families. The education administration department should actively expand high-quality, high school educational resources and increase the demonstration high school acceptance rate. And to increase the number of admissions for the demonstration high school to disadvantaged families with lower social strata to alleviate the pressure of families and students from the high school entrance examination competition. This can not only reduce the participation rate of students’ extracurricular tutoring during the compulsory education stage, but also promote the equalization of high-quality high school entrance opportunities for children of different classes of families.

Food insecurity during COVID-19 pandemic: A genuine concern for people from disadvantaged community and low-income families in Province 2 of Nepal.

BackgroundFood insecurity is a serious social and public health problem which is exacerbated by the COVID-19 pandemic especially in resource-poor countries such as Nepal. However, there is a paucity of evidence at local levels. This study aims to explore food insecurity among people from the disadvantaged community and low-income families during the COVID-19 pandemic in Province-2 of Nepal.MethodsThe semi-structured qualitative interviews were conducted virtually among purposively selected participants (n = 41) from both urban and rural areas in eight districts of Province 2 in Nepal. All the interviews were conducted in the local language between July and August 2020. The data analysis was performed using thematic network analysis in Nvivo 12 Pro software.ResultsThe results of this study are grouped into four global themes: i) Impact of COVID-19 on food security; ii) Food insecurity and coping strategies during the COVID-19 pandemic, iii) Food relief and emergency support during the COVID-19 pandemic, and iv) Impact of COVID-19 and food insecurity on health and wellbeing. Most participants in the study expressed that families from low socioeconomic backgrounds and disadvantaged communities such as those working on daily wages and who rely on remittance had experienced increased food insecurity during the COVID-19 pandemic. Participants used different forms of coping strategies to meet their food requirements during the pandemic. Community members experienced favouritism, nepotism, and partiality from local politicians and authorities during the distribution of food relief. The food insecurity among low-income and disadvantaged families has affected their health and wellbeing making them increasingly vulnerable to the COVID-19 infection.ConclusionFood insecurity among low-income and disadvantaged families was found to be a serious problem during the COVID-19 pandemic. The study suggests that the relief support plan and policies should be focused on the implementation of immediate sustainable food security strategies to prevent hunger, malnutrition, and mental health problems among the most vulnerable groups in the community.

Should ‘free’ childcare be for the most disadvantaged only?

An NAO report suggests funded childcare may damage social mobility because better-off families make better use of entitlements. Three experts assess if it should only be available to disadvantaged families

Behavioural regulation difficulties at primary and secondary school: risk and protection factors

ABSTRACT The present study aims to analyse the risk and protection factors of a sample group of children and teenagers with special educational needs in primary and secondary schools, who require intensive educational support due to the fact that they are experiencing difficulties with behavioural regulation. A theoretical revision is performed of the different ways of compression, in relation to the conduct disorders, the process of acquisition of the capacity of regulation among children, their relationship with adverse life experiences and finally their consequences in adult life. Age, gender, family socioeconomic status (SES), and clinical diagnosis were collected using a consecutive sampling on one hundred children and adolescents (N = 100) who were referred by the schools to two specialised psycho-educational teams. Risk factors such as the presence/absence of addiction in parents or caregivers, mental disorders, or family history in situations of abuse and lack of protection are also considered. The findings suggest that there exists far more demand for intensive support services among boys versus girls, in secondary schools and within socially disadvantaged families. Protection and risk factors that stand out above the others have been identified. The teachers’ awareness of the presence or absence of such factors among students, should allow early detections that might allow the planning of preventive actions in order to promote a full development of people from the point of view of wellbeing and health. The results are discussed in relation to the importance of adopting a socio-ecological and multisystemic approach to address the behavioural problems that in many cases are interpreted as symptoms or expressions of Adverse Childhood Experiences.

Pre-Service Teachers’ Levels of Adaptations to Remote Teaching and Learning at A University in A Developing Country in the Context of COVID-19

The outbreak of Covid-19 pandemic has not only caused fear and uncertainty in the education systems across the globe, but it brought about a fundamental paradigm shift in the mode of teaching and learning. Higher education drastically transitioned to remote/ online delivery even for the students who had enrolled for face-to-face mode of teaching and learning. The paper is premised in the context of a developing country that such a drastic change could have widened the digital divide between students from privileged homes and those from disadvantaged families as students did not receive adequate technological training and to even acquire the necessary electronic devices. Consequently, the study sought to establish the levels of adaptation to remote teaching and learning by university students herein referred to as pre-service teachers. Following a quantitative research design, an online questionnaire survey was administered to 157 pre-service teachers enrolled in a Life Sciences Methodology module at a South African university. Data was analysed using SPSS version 26 and descriptive statistics, exploratory analysis of the questionnaire constructs and One-Way ANOVA tests were conducted to compare pre-service teachers` perceptions, experiences and preparedness. The results showed that the disparities and inequalities that exist in different South African contexts in which pre-service teachers hail from, dictated their levels of adaptations to remote teaching and learning. Those from disadvantaged backgrounds were less adapted as they struggled more when it comes to acquisition of electronic gadgets and connectivity to facilitate remote learning compared to those from advantaged backgrounds. This study affirms the call for education institutions and governments to rethink ways of closing the gap between the poor and the rich in education in terms of resource and other support mechanisms.

Brain Syndemics: Cognitive Deficit, Pathways of Interaction, and the Biology of Inequality

Children born into and raised in disadvantaged families tend to experience poorer health and more developmental delays, lower achievement, and a greater number of behavioural and emotional problems than children from wealthier homes. There is growing evidence that poverty and social inequality leave their imprint on brain structure as well. The brain exhibits considerable plasticity, one expression of which is shaped by the biology of inequality. A specific consequence is cognitive deficit found among children raised in poverty and subject to social discrimination. This paper argues that several pathways impacted by poverty, including chronic stress, malnutrition, exposure to heightened levels of air pollution, and other toxin exposures, syndemically link social inequality to underlying neural mechanisms and to suboptimal brain development and structure. These deficits need not be permanent and are reversible through urgently needed structural, socio-economic intervention.