Inner-city African American Children Research Articles

Endotypes of difficult-to-control asthma in inner-city African American children.

African Americans have higher rates of asthma prevalence, morbidity, and mortality in comparison with other racial groups. We sought to characterize endotypes of childhood asthma severity in African American patients in an inner-city pediatric asthma population. Baseline blood neutrophils, blood eosinophils, and 38 serum cytokine levels were measured in a sample of 235 asthmatic children (6–17 years) enrolled in the NIAID (National Institute of Allergy and Infectious Diseases)-sponsored Asthma Phenotypes in the Inner City (APIC) study (ICAC (Inner City Asthma Consortium)-19). Cytokines were quantified using a MILLIPLEX panel and analyzed on a Luminex analyzer. Patients were classified as Easy-to-Control or Difficult-to-Control based on the required dose of controller medications over one year of prospective management. A multivariate variable selection procedure was used to select cytokines associated with Difficult-to-Control versus Easy-to-Control asthma, adjusting for age, sex, blood eosinophils, and blood neutrophils. In inner-city African American children, 12 cytokines were significant predictors of Difficult-to-Control asthma (n = 235). CXCL-1, IL-5, IL-8, and IL-17A were positively associated with Difficult-to-Control asthma, while IL-4 and IL-13 were positively associated with Easy-to-Control asthma. Using likelihood ratio testing, it was observed that in addition to blood eosinophils and neutrophils, serum cytokines improved the fit of the model. In an inner-city pediatric population, serum cytokines significantly contributed to the definition of Difficult-to-Control asthma endotypes in African American children. Mixed responses characterized by TH2 (IL-5) and TH17-associated cytokines were associated with Difficult-to-Control asthma. Collectively, these data may contribute to risk stratification of Difficult-to-Control asthma in the African American population.

Influence of body dissatisfaction on 1-year change in nutrient intake of overweight and obese inner-city African American children

This analysis aimed to examine the relationship of baseline body dissatisfaction with 1-year change in nutrient intake of inner-city, overweight and obese, African American children. This is a secondary analysis of 1-year pre-post data available for a convenience sample of 88 children. After adjusting for baseline intake of dietary variables and intervention group status, baseline body dissatisfaction was associated with 1-year increases in intake of energy, and all macronutrients in girls, but not in boys. These relationships were not substantially altered after adjusting for baseline BMIz and global self-worth. After including all adjustment factors, increasing baseline body dissatisfaction in girls was associated with 1-year increased intake of total energy, total sugars, total fat, discretionary fat, and total carbohydrates. This analysis suggests that, in girls but not necessarily in boys, body dissatisfaction might need to be targeted during interventions that aim to improve nutrient intake.

One-year change in energy and macronutrient intakes of overweight and obese inner-city African American children: Effect of community-based Taking Action Together type 2 diabetes prevention program

Taking Action Together (TAT) was a controlled community-based intervention protocol developed to reduce risk of T2DM among low-income, high BMI, 9–10year old African American children. A secondary hypothesis of this study was that there would be greater improvements in the treatment group in dietary intakes and physical activity. To evaluate the primary study objectives, multiple linear regression models were employed, with 1year change in dietary variables as dependent variables. Intervention group status was the independent variable of interest and BMIz was included as a covariate in all analyses to adjust for group differences in baseline obesity status of the children. The findings from this analysis suggest that 1year change in dietary intakes in boys was associated with group intervention status, with boys in the treatment group reducing their intakes of energy and fat to a significantly greater extent than boys in the control group. Differences in energy intakes were not significant, however, for girls. Based on the differences in gender response to our comprehensive TAT intervention, we conclude that interventions designed for and delivered only to African American girls might be more successful than those delivered in mixed gender settings.

Exploring Children's Secondhand Smoke Exposure with Early Child Care Providers

Exposure to secondhand smoke (SHS) is a contributor to the increased morbidity and mortality experienced by inner-city African-American children. Limited evidence-based programming exists regarding how to address the negative effects of SHS in this community. A collaboration with an early child care center provided an opportunity to explore factors related to young children's SHS exposure as the first step in developing strategies to reduce exposure. Survey data were obtained between 2008 and 2009 from 63 African-American parents of infants and children aged ≤ 5 years at two early child care centers located in an urban Minneapolis neighborhood. Forty-three of these children had salivary cotinine levels assessed. Parents living below the poverty level were more likely to report that their children were regularly exposed to SHS by family/friends (p = 0.01). Sixty-eight percent of participants reported complete home smoking restrictions, which was significantly correlated with advice from the child's health provider (p = 0.001). Nonsmokers and older parents were less likely to receive advice (p = 0.03). Of the 43 children in whom cotinine levels were assessed, 39.5% had levels > 0.64 ng/ml, which suggests high SHS exposure. Lower cotinine levels were significantly correlated with living in detached houses. Exposure to SHS was common for children in this study. These findings, if supported by additional research, can be used to develop and disseminate targeted health messages about childhood SHS sources/negative effects and strategies to reduce exposure.

Taking Action Together: A YMCA-based protocol to prevent Type-2 Diabetes in high-BMI inner-city African American children

BackgroundAssociated with a tripling in obesity since 1970, type 2 diabetes mellitus (T2DM) in children has risen 9-10 fold. There is a critical need of protocols for trials to prevent T2DM in children.Methods/DesignThis protocol includes the theory, development, evaluation components and lessons learned from a novel YMCA-based T2DM prevention intervention designed specifically for high-BMI African American children from disadvantaged, inner-city neighborhoods of Oakland, California. The intervention was developed on the basis of: review of epidemiological and intervention studies of pediatric T2DM; a conceptual theory (social cognitive); a comprehensive examination of health promotion curricula designed for children; consultation with research, clinical experts and practitioners and; input from community partners. The intervention, Taking Action Together, included culturally sensitive and age-appropriate programming on: healthy eating; increasing physical activity and, improving self esteem.DiscussionEvaluations completed to date suggest that Taking Action Together may be an effective intervention, and results warrant an expanded evaluation effort. This protocol could be used in other community settings to reduce the risk of children developing T2DM and related health consequences.Trial registrationClinicalTrials.gov NCT01039116.

Behavioral characteristics among obese/overweight inner-city African American Children: A secondary analysis of participants in a community-based Type 2 diabetes risk reduction program

This secondary analysis presents psycho-social characteristics of two cohorts of overweight/obese African American children [baseline ( n = 68) and post-intervention ( n = 81)] participating in a community-based, year-long Type 2 diabetes prevention program. The original intervention was designed to incorporate strategies that existent literature deemed most promising with respect to obesity intervention and reduction of Type 2 diabetes risk. Eligible children were assigned to one of two sites and a random process was then used to designate the two sites as either treatment or control. To add to the literature on the psycho-social profiles of overweight children, this analysis considers child and parent caregiver ratings derived from the Behavioral Assessment System for Children, Second Edition-2 (BASC-2; Reynolds & Kamphaus, 2002). For purposes of reference, we index our findings to pre-intervention BASC-2 scores in the baseline cohort as well as to scores of obese children previously reported by others. Parent-reported post-intervention scores favored the intervention condition on three of the four key composites including behavioral symptoms index, internalizing problems and adaptive skills. However, child-reported outcomes showed fewer effects.

Prospective Relationship between Maternal Depressive Symptoms and Asthma Morbidity among Inner-City African American Children

To examine prospective relationships between caregiver's depressive symptoms and child asthma morbidity among inner-city African American families. Phone surveys were conducted 6 months apart with 262 African American mothers of children with asthma. Cross-lagged structural path analysis was used for data analyses. Using goodness-of-fit indices, the final model for asthma symptoms had a good fit to the data. Time 1 (T1) maternal depressive symptoms predicted T2 child asthma symptoms (beta =.16, p <.01); however, T1 asthma symptoms did not predict T2 maternal depressive symptoms (beta =.03, non-significant). In contrast, in the final model for emergency department (ED) visits there was no predictive association between maternal depressive symptoms and ED visits. Maternal depressive symptoms may have a detrimental effect on child asthma morbidity among inner-city African American families, rather than vice versa. Ameliorating maternal depressive symptoms may result in better asthma outcomes for inner-city children.

Using Social Cognitive Theory to Predict Physical Activity in Inner-City African American School Children

Researchers using social cognitive theory and employing built environment constructs to predict physical activity (PA) in inner-city African American children is quite limited. Thus, the purpose of our investigation was to evaluate the ability of important social cognitive variables (e.g., self-efficacy) and built environment constructs (e.g., neighborhood hazards) to predict African American children's PA. Children (N = 331, ages 10-14) completed questionnaires assessing social cognitive theory constructs and PA. Using multiple regression analyses we were able to account for 19% of the variance in PA. Based on standardized beta weights, the best predictors of PA were time spent outside and social support derived from friends. These findings illuminate the valuable role of PA support from peers, as well as the simple act of going outside for inner-city African American children.

Maternal HIV/AIDS and depressive symptoms among inner-city African American youth: the role of maternal depressive symptoms, mother-child relationship quality, and child coping.

This study was designed to examine interactions between psychosocial risk (i.e., maternal depressive symptoms) and protective (i.e., child coping skills and mother-child relationship quality) correlates of depressive symptoms among inner-city African American children of mothers with and without HIV/AIDS. Two primary hypotheses were tested: (a) whether these correlates interact differently in HIV-infected and noninfected samples and (b) whether child coping skills and a positive mother-child relationship interact to protect children from developing depressive symptoms in the context of maternal HIV infection. Results indicated that (a) a positive mother-child relationship, but not child coping skills, was protective in the HIV-infected sample when maternal depressive symptoms were high and (b) the combination of a positive mother-child relationship and child coping skills was associated with the lowest level of child depressive symptoms in the HIV-infected sample. These findings highlight the differential importance of various risk and protective mechanisms for HIV-infected and noninfected African American samples and, as such, have preventative implications for children of HIV-infected women.

A culturally competent asthma management intervention: a randomized controlled pilot study

Despite significant medical advances, many ethnic and racial minority children who live in inner cities continue to experience disproportionately high levels of asthma morbidity and mortality compared with white children. As a result, a growing number of psychosocial asthma management interventions are being developed to address their needs; however, only a few of these interventions have incorporated cultural variables into their treatments and have had their efficacy evaluated. To examine the efficacy of the Multifamily Asthma Group Treatment (MFAGT), designed to enhance asthma management and reduce emergency department (ED) visits among African American and Hispanic families. Twenty-four African American and Hispanic families who have children with asthma were randomly assigned to either the MFAGT or the Standard Psychoeducational Asthma Intervention. Differences in the number of ED visits and the level of asthma management in both groups were compared 1 year before and 1 year after the intervention. In addition, these groups were contrasted to a control group that did not receive any psychoeducational intervention. The MFAGT was significantly (P = .04) more effective than the Standard Psychoeducational Asthma Intervention and the control in decreasing ED visits and increasing parental asthma knowledge. These preliminary results suggest that the MFAGT is efficacious in enhancing asthma management and in reducing ED visits in inner-city African American and Hispanic children from a lower socioeconomic background.

Maternal Age, Alcohol Abuse History, and Quality of Parenting as Moderators of the Effects of Prenatal Alcohol Exposure on 7.5‐Year Intellectual Function

In contrast to the extensive literature documenting IQ deficits in patients with fetal alcohol syndrome, effects on IQ have not generally been reported for children with alcohol-related neurodevelopmental disorder (ARND). This study examined the role of maternal age, MAST, and quality of parenting in moderating the effects of prenatal alcohol exposure on the WISC-III IQ test in moderate-to-heavily exposed children. A total of 337 inner-city African American children whose mothers were recruited prenatally were administered the WISC-III at 7.5 years. Alcohol exposure was assesed with a timeline follow-back interview administered at every prenatal clinic visit. Moderating effects of the three risk factors were examined by adding interaction terms to regression analyses and dichotomizing the moderators and performing separate regressions on the two groups. Prenatal alcohol exposure was related to WISC-III Freedom from Distractibility but not to Full Scale IQ for the sample as a whole. However, among children born to older mothers, an alcohol effect emerged on Full Scale IQ and five of seven composite IQ scores. Similarly, adverse effects were seen among children of MAST-positive mothers and children whose parents provided less optimal cognitive stimulation. Each additional ounce of absolute alcohol consumed per day during pregnancy was associated with a 2.9-point decrease in Full Scale IQ and a 5.6-point decrement on Freedom from Distractibility. This study is the first to demonstrate IQ effects among children with ARND born to older and MAST-positive mothers, particularly in relation to first-trimester drinking. These findings suggest that there are subgroups of more vulnerable and severely affected children whose intellectual performance is compromised. A moderate- to heavy-drinking mother who has given birth to an unaffected child when she was younger needs to be warned that her risk of having an adversely affected child increases as she grows older.

Feasibility of an Anxiety Preventive Intervention for Community Violence Exposed African-American Children

Investigated the feasibility of using an anxiety preventive intervention efficacious with Australian children with inner-city African-Americans (aged 10–11) who experienced moderate anxiety problems and community violence exposure. Of 91 fifth-grade students, ten participated in the school-based selective preventive intervention that targeted anxiety disorders. In this pilot study, qualitative and quantitative analyses revealed significant decreases in general anxiety and manifestations of anxiety that were contextually relevant to the community violence exposed youth (i.e., physiological symptoms, worry regarding environmental pressures, and concentration difficulties). The discussion focuses on the modifications necessary to make the prevention program culturally and contextually appropriate for anxious inner-city African-American children.

Assessing Anxiety Sensitivity in Inner-City African American Children: Psychometric Properties of the Childhood Anxiety Sensitivity Index

This study examined the psychometric properties of the Childhood Anxiety Sensitivity Index (CASI; Silverman et al., 1991) in a sample of urban African American elementary school children. One hundred forty-four 4th- and 5th-grade children completed the CASI as part of a larger project. In contrast to prior research with community samples, CASI total scores were higher and means did not differ by sex. Internal consistency (α = .82), 2-week test–retest reliability (r = .80), and convergent and divergent validity were good and consistent with prior research. The factor structure of the CASI differed from the structure found with White children. Results of exploratory factor analyses suggest two factors: physical concerns and mental incapacitation concerns. Implications for assessing anxiety and anxiety sensitivity among African American children are discussed.

Exploring the intragroup conflict constructs and behaviors of African American public school children in an inner‐city conflict resolution education (CRE) program

AbstractThe Consortium on Negotiation and Conflict Resolution's (CNCR) Conflict Resolution in Schools Program (CRiSP) conducted a two‐year study of inner‐city African American public school children to discern any conflict constructs and behaviors that were apparent in the children's intragroup interactions. This article presents findings of the CNCR study, including three emergent themes—fears of victimization, identity conflict, and core values—that were consistently apparent in the children's demonstrations of intragroup conflict constructs and behaviors.

Different forms of aggression among inner-city African–American children: Gender, configurations, and school social networks

Using narrative reports of peer conflicts among a sample of African–American children and adolescents from inner-city schools, this study investigated the development and social functions of four types of aggressive behaviors: social, direct relational, physical, and verbal aggression. A total of 489 participants in grades 1, 4, and 7 were interviewed (220 boys and 269 girls). Results showed that low levels of social aggression and high levels of physical aggression were reported in peer conflicts. Gender differences on social, direct relational, and physical aggression were primarily observed in the comparisons of same-gender conflicts at grade 7. Distinct configurations were identified across different forms of aggression. Boys with configurations of physical and/or verbal aggression had higher levels of school social network centrality than non-aggressive boys. Girls with configurations of social and/or direct relational aggression showed relatively higher levels of network centrality than non-aggressive girls.

Black Milwaukee’s Challenge to the Cycle of Urban Miseducation

Milwaukee’s two African American Immersion schools—public schools that infused African and African American themes into the state’s prescribed curriculum—officially opened in 1990 and 1991. Inner-city African American residents and school officials in Milwaukee prompted the call for their establishment. It was hoped that these African-centered schools would serve as a model for the city’s public school system to effectively combat the disparaging statistics associated with African American students. Needless to say, the proposition was controversial but at the same time historically significant. Black Milwaukee’s call for schools, reflective of their culture and educational expectations, was not a spur-of-the-moment proposal; it was a response to the city’s continued inability to effectively educate African American children. Arguably, it was an initiative more than 40 years in the making. Accordingly, Milwaukee’s African American Immersion schools can be seen as a beginning and an end for inner-city Black Milwaukeeans. The schools were a beginning because they signified a new direction of educational reform in the city, one specific to the educational needs of inner-city African American children. Concomitantly, the establishment of these two African American Immersion schools can be seen as an end result of more than two generations of struggle for equitable opportunities and school reform in Milwaukee.

A Longitudinal Examination of Correlates of Depressive Symptoms Among Inner-City African-American Children and Adolescents

We longitudinally examined across four years the presence and correlates of depressive symptoms in a sample of inner-city African-American children, an ethnic minority population which is understudied regarding child depressive symptoms. Results, based on mother- and child-report, did not indicate gender differences in depressive symptoms at the onset of adolescence. However, depressive symptoms did significantly predict future child adjustment problems. Implications for the understanding and future study of depressive symptoms in ethnic minority youth are discussed.

Aggression in Inner-City Early Elementary Classrooms: Individual and Peer-Group Configurations

While recent investigations suggest that subtypes of aggressive youth differentially experience social support for problem behavior, little work has examined if this holds for younger children. This study examined the classroom social structure and social functioning of inner-city African American early elementary school children. Ninety-two (53 boys, 39 girls) 1st graders from two inner-city schools were followed for two years. Configural analysis uncovered considerable heterogeneity in the relationships among overt aggression, popularity, and social network centrality. Two subsets of aggressive students were identified, one marked by high social prominence, the other by low levels of popularity. Peer groups marked by the behavioral similarity of constituent members were identified, and changes in affiliation patterns over time indicated selection criteria.

Coping strategies and behavior problems of urban African-American children: concurrent and longitudinal relationships.

The development and correlates of 82 inner-city African-American children's coping strategies were examined across three years. Results indicated no change in the mean frequency of self-reported coping strategies over the three years, and a significant correlation of emotion-focused strategies with increased self- and mother-reported behavior problems. Child-reported externalizing problems (and, to a lesser degree, internalizing problems) predicted changes in coping strategies across assessments.

Ethnic Identity Assessment among Inner-City African American Children: Evaluating the Applicability of the Multigroup Ethnic Identity Measure

Phinney's (1992) Multigroup Ethnic Identity Measure (MEIM) was administered to 118 African American children between the ages of 8 and 12 years who lived in an impoverished inner-city neighborhood. This study examined the scale's reliability in measuring feelings of ethnic affirmation and belonging, ethnic behaviors, and ethnic knowledge in a sample of urban children. Results of the reliability analyses were mixed, and indicated that the constructs of ethnic behavior and identity achievement were less stable in this population. Potential implications of differences in cognitive development and social experiences between younger children and adolescents as well as contextualfactors such as socioeconomic status are considered in the discussion of the results.