Cumulative Risk Effect Research Articles

Similarities and Differences in Risk Factors for Violent Offending and Gang Membership

Prior research has established that there is a cumulative effect of risk factors on both youth violence and gang membership and that risk factors in multiple domains increase the probability of youth violence and gang involvement. In this article we expand upon this risk factor approach to the study of youth violence by addressing two questions concerning youth violence: (1) What are the effects of cumulative risk, including risk in multiple domains, on youth violence and gang membership and to what extent are the patterns similar or different for youth violence and gang membership? (2) To what extent do risk factors exert independent effects when other factors are controlled in multivariate analyses, and are the risk factors for youth violence similar to or different from those for gang membership? We utilise survey data from a sample of 5,395 8th grade students in 11 cities across the United States to examine these issues.

The Effect of Cumulative Risk on Paternal Engagement: Examining Differences Among Adolescent and Older Couples

This study examined the association between fathers’ and mothers’ risk factors and paternal engagement 1 and 3 years postbirth. Distinguishing between new and persistent risk factors, we tested whether cumulative risk has unique effects on couples where one or both parents are adolescents at birth. Results indicated that although fathers’ and mothers’ risk factors affected levels of paternal engagement with 1-year-olds, these effects did not differ among couples with at least one adolescent and older couples. However, when the child was 3, fathers’ risk factors were stronger predictors of decreased engagement for couples with at least one adolescent partner, but mothers’ risk factors increased engagement only for adolescent fathers with older mothers. Implications for policy and practice are discussed.

Cumulative risk and AIDS-orphanhood: Interactions of stigma, bullying and poverty on child mental health in South Africa

Research shows that AIDS-orphaned children are more likely to experience clinical-range psychological problems. Little is known about possible interactions between factors mediating these high distress levels. We assessed how food insecurity, bullying, and AIDS-related stigma interacted with each other and with likelihood of experiencing clinical-range disorder. In South Africa, 1025 adolescents completed standardised measures of depression, anxiety and post-traumatic stress. 52 potential mediators were measured, including AIDS-orphanhood status. Logistic regressions and hierarchical log-linear modelling were used to identify interactions among significant risk factors. Food insecurity, stigma and bullying all independently increased likelihood of disorder. Poverty and stigma were found to interact strongly, and with both present, likelihood of disorder rose from 19% to 83%. Similarly, bullying interacted with AIDS-orphanhood status, and with both present, likelihood of disorder rose from 12% to 76%. Approaches to alleviating psychological distress amongst AIDS-affected children must address cumulative risk effects.

The relations among cumulative risk, parenting, and behavior problems during early childhood.

This study examined relations among cumulative risk, nurturant and involved parenting, and behavior problems across early childhood. Cumulative risk, parenting, and behavior problems were measured in a sample of low-income toddlers participating in a family-centered program to prevent conduct problems. Path analysis was utilized to examine longitudinal relations among these constructs, with results supporting an indirect effect of cumulative risk on externalizing and internalizing problems through nurturant and involved parenting. Results highlight the importance of cumulative risk during early childhood, and particularly the effect that the level of contextual risk can have on the parenting context during this developmental period.

Geographical variations in hip fracture risk for women: strong effects hidden in standardised ratios

There was 75% variation in the trend in hip fracture incidence with age in women aged 50 to 85 in France. In southwest France, the women are at higher risk of hip fracture at younger ages. This finding should be taken into account when examining risk factors. Few studies have analysed the geographical variations in the relationship between age and hip fracture incidence. Our goal was to assess these variations among women under 85 within the same country. The study population included women aged 50 to 85 who were living in France in 2004. Hip fracture cases were identified in the French Diagnosis Related Groups (DRG)-like database using the diagnosis code for closed hip fractures and procedural codes for treatment. The Moran index and a spatial model using latitude and longitude were used to assess the geographical heterogeneities of cumulative incidence risk (CIR) and age effect. A total of 29,218 hip fracture cases were identified. A south-to-north CIR gradient ranging from 7 to 16% was observed. The variation in the number of years until double hip fracture incidence was 75% (i.e. 1.49 to 2.57 years). In the south, and more markedly in southwest France, the women are at higher risk of hip fracture at a younger age. The risk of fracture may be different between women of the same age. This may be hidden in a comparison of standardised ratios. This finding should be considered when examining risk factors and implementing public health interventions.

Childhood Socioeconomic Position, Gender, Adult Body Mass Index, and Incidence of Type 2 Diabetes Mellitus Over 34 Years in the Alameda County Study

We examined the association between childhood socioeconomic position and incidence of type 2 diabetes and the effects of gender and adult body mass index (BMI). We studied 5913 participants in the Alameda County Study from 1965 to 1999 who were diabetes free at baseline (1965). Cox proportional hazards models estimated diabetes risk associated with childhood socioeconomic position and combined childhood socioeconomic position-adult BMI categories in pooled and gender-stratified samples. Demographic confounders and potential pathway components (physical inactivity, smoking, alcohol consumption, hypertension, depression, health care access) were included as covariates. Low childhood socioeconomic position was associated with excess diabetes risk, especially among women. Race and body composition accounted for some of this excess risk. The association between childhood socioeconomic position and diabetes incidence differed by adult BMI category in the pooled and women-only groups. Adjustment for race and behaviors attenuated the risk attributable to low childhood socioeconomic position among the obese group only. Childhood socioeconomic position was a robust predictor of incident diabetes, especially among women. A cumulative risk effect was observed for both childhood socioeconomic position and adult BMI, especially among women.

Mothering and Peer Associations Mediate Cumulative Risk Effects for Latino Youth

The present study examined whether positive parenting and deviant peer associations mediated the relations between a cumulative risk composite comprising financial strain, neighborhood problems, and maternal psychological distress and subsequent youth adjustment problems. Drawn from the Welfare, Children, and Families: A Three City Study, the sample consisted of 449 economically disadvantaged Latino families. Structural equation modeling showed that after controlling for baseline levels of youth adjustment problems, cumulative risk, assessed when adolescents were 10 to 14 years old, was directly and indirectly predictive of youths’ deviant peer associations 16 months later, through mother’s positive parenting. Deviant peer associations, in turn, were proximally associated with youth externalizing and internalizing problems. Findings underscore the role of mothers and peers in Latino youth adjustment problems.

The role of child temperament on Head Start preschoolers' social competence in the context of cumulative risk

This study examined the main and interactive effects of cumulative risk and child temperament on teacher ratings of social competence and observer ratings of peer play in a sample of Head Start preschoolers. A cumulative risk index (CRI) was computed by summing the total number of risk factors for each family. There was a difference in the predictive power of the CRI when it consisted of 10 (including child temperament) versus 8 possible risk factors (excluding child temperament) for teacher ratings of social competence. The CRI based on 10 risk factors was related significantly and negatively to social competence. A significant interaction between inhibited child temperament and cumulative environmental risk revealed that highly inhibited children were perceived by their teachers as equally competent under both high- and low-risk, whereas less inhibited children received lower ratings as environmental risk increased. Less inhibited and less impulsive temperament emerged as promotive factors associated with high levels of interactive peer play and teacher ratings of social competence, respectively, regardless of the risk level.

Early Parenting Intervention: Family Risk and First-time Parenting Related to Intervention Effectiveness

The effects of cumulative risk and parity on the effectiveness of a home based parenting intervention were tested in a randomized controlled trial with 237 families with 1- to 3-year-old children screened for high levels of externalizing behavior. The intervention was aimed at enhancing positive parenting and decreasing externalizing behaviors. The results showed that cumulative risk was not associated with either change in child externalizing behaviors or change in positive parenting. When intervention effectiveness was compared for primiparas (i.e., first-time mothers) versus multiparas (i.e., mothers with more than one child), we found that intervention mothers of first-born children displayed an increase in their use of positive discipline strategies as compared to first-time mothers in the control group, whereas a similar effect for multiparas was absent. Among multiparas we found an intervention effect on sensitivity, with control group mothers showing an increase in sensitivity, whereas the intervention group showed a constant level of sensitivity over time. These results suggest that parity may be a moderator of intervention effectiveness. Implications for investigating moderators of intervention effectiveness are discussed.

Cumulative risk of overweight in U.S. adolescents supports a social ecology model of obesity

The social ecology model of overweight recognizes both proximal behavioral and broader environmental risk factors (RF). This study aimed to validate the model using data from the National Longitudinal Study of Adolescent Health (Add Health). Survey items for 6073 respondents were used to calculate relative risk (RR) for 30 variables representing sociodemographic and behavioral RF for overweight. Fourteen RF were identified as significant [P(RR=1)<0.05]. The number of significant RF was counted for each participant, and a cumulative risk model was created reflecting incidence of overweight with increasing number of RF (Figure 1). Participants were divided into quartiles for total risk factors. RR of overweight for quartiles 2–4 compared to quartile 1 are as follows (quartile: RR [95% CI]): second: 1.5 [1.3–1.8]; third: 1.9, [1.6–2.2]; fourth: 2.3 [2.0–2.7]. Risk for overweight increased in a dose dependent manner with increasing risk factors (p < 0.05). Consideration of the total number of risk factors explains more risk variation than consideration of any single risk factor. This significant cumulative risk effect supports the social ecology model of overweight, as increases in total risk cannot be explained by either sociodemographic or % > 85th BMI percentile∗ behavioral RF in isolation. Research supported by the Brigham Young University Honors Program. Figure 1Open in figure viewerPowerPoint Cumulative risk of overweight

Examining Resource and Protective Factors in the Adjustment of Latino Youth in Low Income Families: What Role Does Maternal Acculturation Play?

This longitudinal study examined whether the risk and positive factors contributing to the delinquent behaviors and internalizing problems of 454 Latino adolescents varied across maternal linguistic acculturation and adolescent gender. Although the level of cumulative risk to which the 10-to-14-year old adolescents were exposed did not vary by maternal linguistic acculturation, the factors contributing to their subsequent adjustment 16 months later varied substantially. Multiple regression analyses showed that for boys, maternal monitoring offset cumulative risk effects in the high acculturation group, but was unrelated to adjustment in the low acculturation group. Social competence served a protective function for boys in the high acculturation group, but was detrimental for boys in the low acculturation group and mother-son relationship quality directly predicted more subsequent delinquent behaviors among boys in the low acculturation group. Maternal monitoring was the only positive factor contributing to girls’ adjustment, directly predicting fewer delinquent behaviors for all girls.

The Effects of Cumulative Risks and Promotive Factors on Urban Adolescent Alcohol and Other Drug Use: A Longitudinal Study of Resiliency

Resiliency theory provides a conceptual framework for studying why some youth exposed to risk factors do not develop the negative behaviors they predict. The purpose of this study was to test compensatory and protective models of resiliency in a longitudinal sample of urban adolescents (80% African American). The data were from Years 1 (9th grade) and 4 (12th grade). The study examined effects of cumulative risk and promotive factors on adolescent polydrug use including alcohol, tobacco and marijuana. Cumulative measures of risk/promotive factors represented individual characteristics, peer influence, and parental/familial influences. After controlling for demographics, results of multiple regression of polydrug use support the compensatory model of resiliency both cross-sectionally and longitudinally. Promotive factors were also found to have compensatory effects on change in adolescent polydrug use. The protective model of resiliency evidenced cross-sectionally was not supported in longitudinal analysis. The findings support resiliency theory and the use of cumulative risk/promotive measures in resiliency research. Implications focused on utilizing multiple assets and resources in prevention programming are discussed.

Attachment and Attention: Protection in Relation to Gender and Cumulative Social‐Contextual Adversity

Data from 918 children from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care were examined to test the interrelation of attachment and attentional performance and 2 known risks for poor attentional performance: male gender and social-contextual adversity. Attachment was measured using the Strange Situation at 15 months, attentional performance by a Continuous Performance Test (CPT) and maternal questionnaires at 54 months, and social-contextual adversity by a variety of measures from birth to 54 months. Findings indicated (a) that children with secure attachment were less susceptible to the effects of cumulative risk and gender on CPT attentional performance than their insecure counterparts and that (b) no such differential risk susceptibility was evident for maternal reports of attention-related behavior problems.

When more is not better: the role of cumulative risk in child behavior outcomes

Cumulative risk research has established the deleterious effects of co-occurring risk factors on child behavior outcomes. However, extant literature has not addressed potential differential effects of cumulative risk at different points in development and has left open questions about whether a threshold model or a linear risk model better describes the impact of cumulative risk on behavior outcomes. The current study examined the impact of cumulative risk factors (i.e., child maltreatment, inter-parental violence, family disruption, low socioeconomic status, and high parental stress) in early and middle childhood on child behavior outcomes in adolescence. Using data from an ongoing longitudinal study of at-risk urban children (N=171), the cumulative effects of these five risk factors across early and middle childhood were investigated. The findings support the cumulative risk hypothesis that the number of risks in early childhood predicts behavior problems in adolescence. Evidence for a linear but not a threshold model of cumulative risk was found; the more risks present, the worse the child outcome. Moreover, the presence of multiple risks in early childhood continues to explain variations in predicting adolescent behavior outcomes even after including the effects of risk in middle childhood. The results support the need for comprehensive prevention and early intervention efforts with high-risk children, such that there does not appear to be a point beyond which services for children are hopeless, and that every risk factor we can reduce matters.

Environmental influences on child mental health

To present an up-to-date review about environmental influences on child mental health, describing major risk factors and discussing recommendations for intervention by pediatricians. MEDLINE, PsycLIT and Lilacs, technical books and publications about child development and child and adolescent mental health problems and health promotion. Children are exposed to multiple risk factors, among them high prevalence of disease, premature birth, being born from a problematic pregnancy, and living in poverty. This negative chain of events increases the risk for emotional problems. The negative effects on development and behavior result from the complex interaction between genetic, biological, psychological and environmental risk factors. The main factors influencing the mental health of children are the social and psychological environment. The cumulative risk effect is more important in determining emotional problems in children than the presence of one single stressor, regardless of its magnitude. Environmental factors play an important role in the etiology of emotional problems in childhood. An adequate clinical investigation allows pediatricians to identify risk factors for the development of mental health problems and to ensure early intervention for children at risk.

The role of resource, protective, and risk factors on academic achievement‐related outcomes of economically disadvantaged Latino youth

AbstractWe examined the effects of cumulative risk, resource, and protective factors on the language and math achievement scores and school problem behaviors of a sample of 549 10–14‐year‐old, economically disadvantaged Latino youths. Findings indicated that as the number of risk factors increased, youth's language and math achievement scores decreased and school problem behaviors increased. Hierarchical regression analyses revealed that each of the hypothesized resource variables (i.e., maternal monitoring, maternal academic involvement, socioemotional competence, and extracurricular activity) made a unique contribution to at least one achievement‐related outcome, over and above the effects of cumulative risk. Moreover, maternal monitoring buffered the effects of multiple risk factors on language achievement scores. Contrary to expectations, higher levels of participation in extracurricular activities had a detrimental effect on male school problem behavior scores and was unrelated to girl's problem behavior scores. © 2003 Wiley Periodicals, Inc. J Comm Psychol 31: 513–529, 2003.

Infant-mother attachment security, contextual risk, and early development: a moderational analysis.

In light of evidence that the effects of attachment security on subsequent development may be contingent on the social context in which the child continues to develop, we examined the effect of attachment security at age 15 months, cumulative contextual risk from 1 to 36 months, and the interaction of attachment and cumulative risk to predict socioemotional and cognitive linguistic functioning at age 3 years, using data from the National Institute of Child Health and Human Development Study of Early Child Care. Results indicated that early attachment predicts both socioemotional development and language skills, but not cognitive functioning as indexed by a measure of school readiness, and that the effect of attachment on socioemotional development and expressive language varied as a function of social-contextual risk. Insecure-avoidant infants proved most vulnerable to contextual risk, not children classified as secure or insecure more generally, although in one instance security did prove protective with respect to the adverse effects of cumulative contextual risk. Findings are discussed in terms of risk and resilience and in light of the probabilistic nature of the relation between early attachment and later development.

Type and timing of mothers' victimization: effects on mothers and children.

There is mounting concern about how mothers' own victimization experiences affect their children. This study examines the effects of mothers' victimization on their own mental health and parenting and on their children's behavior, development, and health. The effects of both timing and type of victimization are assessed. A related objective was to determine if there was a cumulative risk effect produced by victimization during both childhood and adulthood, or both physical and sexual. Urban families in an eastern state and urban and rural families in a southern state. A total of 419 mothers and their children 6 to 7 years old were identified from 2 sites. The eastern sample was recruited in the first 2 years of life from 3 pediatric clinics: 1 for children at high risk for human immunodeficiency virus disease, 1 for children with failure to thrive, and a third providing pediatric primary care. The southern sample was derived from a cohort of children at risk for adverse health or developmental outcomes, plus a systematic sampling of controls, recruited from area hospitals. At age 4, a random sample of children from the original cohort who had been maltreated along with a matched comparison group of nonmaltreated children were selected. In general, mothers victimized during both childhood and adulthood had poorer outcomes than mothers victimized during either childhood/adolescence or adulthood who in turn had worse outcomes than mothers with no history of victimization. This manifested as more maternal depressive symptoms, harsher parenting, and more externalizing and internalizing behavior problems in their children. There were no significant differences in maternal functioning or child outcomes between those abused in childhood and those abused in adulthood. These findings were similar for type of victimization. Mothers' depression and harsh parenting were directly associated with their children's internalizing and externalizing behavior problems. Maternal victimization appears to be a highly prevalent problem in high-risk samples and is associated with harmful implications for mental health and parenting, as well as for the offspring. Pediatricians need to consider past and current victimization of mothers. Routine screening for these problems, followed by appropriate evaluation and intervention may reduce maternal depression, improve parenting, and reduce the incidence of behavior problems in children.

Risk factors for suspicion of developmental delays at 12 months of age

OBJECTIVE: To investigate the prevalence of positive screening test for developmental delays in a cohort of children born in Pelotas, Brazil in 1993, and their risk factors. METHODOLOGY: A sample of 20% (1,363 children) of a cohort of children born in Pelotas, Brazil, was studied at 12 months of age regarding their development. The Denver II Test was used. The children who failed in two or more items of the test were suspected of having development delay. A set of independent variables was chosen taking into account the hierarchical relations between risk factors according to the conceptual framework (socioeconomic, reproductive and environmental, birth conditions, childreńs care, nutrition and morbidity). Analyses were performed using Mantel-Haenszel X2 and multivariate technique through conditional logistic regression, to control for possible confounding. RESULTS: At 12 months of age, 34% (463) of the total of 1,363 children failed in the screening test. After adjusting for possible confounding variables, failure was associated with family lower income children (OR= 1.5), very low birth weight (OR= 4.0), gestational age less than 37 weeks (OR= 1.6), more than three siblings (OR= 1.9), and duration of breastfeeding less than three months (OR=1.6), or no breastfeeding (OR= 1.9). Children who presented weight/age at six months of age less or equal to -2 z score of the reference population presented a risk 10 times greater of having failure in the Denver II Test. CONCLUSIONS: This study reinforces the multiple etiology of development delays and the concept of cumulative risk effect. In this population those who are economically disadvantaged accumulate risk factors (social, economic and environmental) that may render to deficits in their development.

First births among unmarried adolescent girls: Risk and protective factors

In this longitudinal investigation the authors drew on cumulative risk theories to provide new evidence about the effects of sociodemographic risk factors for adolescent nonmarital childbearing among 958 girls in a nationally representative sample. The effect of a cumulative risk index was highly significant-adolescent girls who experienced five or more sociodemographic risk factors were 16 times more likely than their counterparts with only one risk factor to experience a nonmarital childbirth during the teenage years. The authors also examined the role of hypothesized protective factors-including high self-esteem high basic skills and high educational expectations-in interaction with the cumulative risk index. Findings suggest that under similar levels of sociodemographic risk adolescent girls with high educational expectations are less likely to experience a nonmarital birth. However the buffering effects of high educational expectations account for comparatively less than cumulative risk effects on nonmarital childbearing during adolescence. (authors)