Low Socioeconomic Status Families Research Articles

Daily screen time, sleep pattern, and probable sleep bruxism in children: A cross-sectional study.

This study aimed to evaluate the prevalence of probable sleep bruxism (SB) in children aged 7-8 years and its association with sleep pattern and the time spent using devices with a screen. A cross-sectional study was conducted with children from Pelotas, Brazil (n=556). Parents/caregivers were interviewed and provided demographic/socioeconomic information, children's daily screen time, nighttime tooth grinding or clenching, sleep duration and answered the Biological Rhythms Interview for Assessment in Neuropsychiatry for Kids (BRIAN-K-sleep domain). Probable SB was determined based on a positive clinical inspection with/without a positive parental/caregiver's reports of tooth clenching or grinding. Hierarchical Poisson regression was performed. The prevalence of probable SB was 15.83% (n=88). There was no difference in the probable SB prevalence according to the daily screen time (p=0.744), and low family socioeconomic status was associated with higher SB prevalence (Prevalence Ratio [PR]=1.95; 95% Confidence Interval [95% CI]: 1.21-3.17; p=0.006). Higher scores in the sleep domain of the BRIAN-K scale were associated with probable SB [PR=1.07; 95% CI: 1.01-1.30; p=0.013]. Difficulties in maintaining sleep and low family socioeconomic status were associated with probable SB in schoolchildren, while screen time spent using devices with a screen was not associated.

Prevalencia de sobrepeso y obesidad en Aragón y variaciones según condicionantes de salud

IntroductionChildhood obesity is a serious global health problem that is continuously increasing worldwide. Many studies suggest that socioeconomic factors are related to the development of obesity. The objective of our study was to analyse the prevalence of overweight and obesity in Aragón, calculated applying the World Health Organization (WHO) growth standards, and to study its association with socioeconomic factors. Material and methodsWe collected data for the entire paediatric population of Aragón aged 2–14 years. We classified each child as normal weight, overweight or obese based on the body mass index. We calculated prevalences by province and basic health care zone. To analyse differences in relation to social inequalities, we used the Aragón deprivation index as an indicator of socioeconomic status. ResultsThe final sample consisted of 161 335 children aged 2–14 years, 51% male and 49% female. The overall prevalence of excess weight was 31.1% (17.7% overweight and 13.3% obesity) and was significantly higher in boys. We found a high frequency of under-recording in health records (65%).There was a direct association between the deprivation index and the prevalence of obesity and overweight throughout Aragón, with a significant strong correlation in urban areas, where socioeconomic factors explained up to 66.4% of obesity and 48.9% of body weight excess. ConclusionsIn Aragón, the prevalence of obesity and excess weight is high and associated with low family socioeconomic status.

Working and non-working conditions related to the presence of depressive symptoms in women workers with subsistence jobs in the centre of Medellín, 2015–2019

ObjectiveTo determine the working and non-working conditions related to depressive symptoms in informal workers in the centre of Medellín in 2015–2019. MethodsCross-sectional study with analytical intention and primary sources of information. Data collection with assisted survey in one of its union headquarters in 2016, after a pilot test and standardisation of pollsters. A total of 291 women workers were taken as a census, and their working and non-working conditions were explored. ResultsThe women had an average age of 45 years, ≤5 years of schooling, low and middle-income housing, and income below the 2016 minimum wage. About 60% suffered moderate-severe food insecurity, and received no state benefits. They were mainly the head of the family, with 1 or 2 dependents, and were responsible for the work at home. They worked at least 8 h a day, 6 or 7 days a week, with parents or relatives selling in the street, and at least 20 years in their work. About 60% had a partner, 21.6% with family dysfunction, and 15.4% moderate-severe depressive symptoms. Living in one room or a slum, with a low socioeconomic status and moderate-severe family dysfunction were associated with, and contributed to the explanation of, moderate-severe depressive symptoms. ConclusionsThe non-working conditions that are associated with and explain the moderate-severe depressive symptoms of female workers can be modified with actions that impact on the social determinants of health.

Developmental risk sensitivity theory: the effects of socio-economic status on children's risky gain and loss decisions.

Evolutionary developmental theories propose that early environments shape human risk preferences. Developmental risk sensitivity theory (D-RST) focuses on the plasticity of risk preferences during childhood and makes predictions about the effect of reward size based on a child's social environment. By contrast, prospect theory predicts risk aversion for gains and risk seeking for losses regardless of environment or status. We presented 4 to 10-year-olds (n = 194) with a set of trials in which they chose between a certain amount and a chance to receive more or nothing. Two trials were equal expected value choices that differed by stake size and two were unequal expected value choices. Children either received gain trials or loss trials. Social environment was assessed using socio-economic status (SES) and subjective social status. Results confirmed the predictions of D-RST for gains based on SES. Children from lower-SES families differentiated between the high- and low-value trials and made more risky decisions for the high-value reward compared with higher-SES children. Children from higher-SES families were more risk averse for both trial types. Decisions for loss trials did not conform completely to either theory. We discuss the results in relation to evolutionary developmental theories.

Effects of Parent-Implemented Language Intervention on Communication Skills of Iranian Toddlers: A Pilot Randomized Control Trial

Introduction: In recent years, some studies have indicated that some aspects of language performance of children from low socioeconomic status (SES) families are lower in language tests. Appropriate and timely interventions can partially prevent communication problems in these children. This study aimed to investigate the effect of a parental education program on word acquisition rates in Iranian toddlers from low SES families.
 Materials and Methods: Sixty-six mothers (toddlers aged 12-14 months) participated in this randomized controlled trial study. These mothers were allocated to the experimental group and control group using the randomization method of the permuted block (each block=6). After baseline assessments, mothers in the experimental group received parental education program aimed at enriching the mother-child interactions and mothers’ knowledge of communication development for 9 weeks. The control group did not receive any education. The outcome measures were children’s scores on the Persian version of the McArthur-Bates communicative development inventories and mothers’ scores in multiple-choice exams regarding workshops’ contents. Data were analyzed using of Chi-square test, independent t test and paired samples t-test, Mann-Whitney U-test, and Wilcoxon signed-rank test.
 Results: Both groups had a significant increase in vocabulary size, while changes in the experimental group were more than double that of the control group (P<0.001). Other aspects of communicative behaviors, such as imitation, naming, and intentionality were changed only in the experimental group according to the course of typical development (P<0.001). Mothers significantly got higher scores after the workshops in a multiple-choice exam regarding children’s communication, language, and interaction (P<0.001).
 Conclusion: The results demonstrate that mothers’ knowledge of communication development is malleable and probably has positive effects on the communication behaviors of toddlers from low SES backgrounds.

Home-Visiting in a Shared Reading Intervention: Effects on Children from Low SES and Ethnic Minority Families

ABSTRACT Research Findings: In this study, we examined the short- and long-term effects of Reading Express, a home-visiting intervention in which volunteers encourage low socio-economic status and ethnic minority parents to engage in interactive shared reading with their child. Outcomes of a quasi-experiment involving 176 children in the Netherlands (mean age 72 months; nexperimental = 95; ncontrol = 81) revealed favorable outcomes of Reading Express for children’s home literacy environments (i.e., children’s book exposure and parents’ reported shared reading frequency), which were maintained over time. Reading Express also had a positive short-term effect on story comprehension. However, the positive trend in story comprehension leveled off 20 weeks after program termination and there were neither short-term nor long-term effects on receptive vocabulary. Practice or Policy: Our results show that longer-term changes can be made in children’s home literacy environments by means of home visiting programs such as Reading Express, but they also suggest the relevance of better adapting programs to the characteristics and needs of participating families.

“If they made it, why not me?” increasing educational expectations of Roma and Moroccan immigrant families in Spain through family education

ABSTRACT In Europe, Roma and immigrant students continue to experience great inequities, as they face the probabilities of educational failure, segregation, and early school leaving. Previous research has shed light on the multiple factors that perpetuate this situation. However, the role played by family involvement and family educational expectations have been considered to a lesser extent. This research delves into how Family Education programmes provided by eight Spanish schools are playing a central role in increasing Roma and Moroccan families’ expectations of their children’s education. Based on the communicative methodology, this study was conducted in schools located in five Spanish regions. The schools serve minority students from low-socioeconomic status (SES) families and provide Family Education programmes in their own facilities. We applied a convergent mixed methods design, implementing qualitative and quantitative data collection techniques (semistructured interviews, communicative focus groups, communicative daily life stories, and questionnaires). The sample included Roma and Moroccan family members with low SES and teachers involved in Family Education. The results suggest that Family Education is increasing minority families’ educational expectations of their children’s education. Three elements have been identified as facilitators: 1) the co-creation of a high expectations climate in the schools; 2) the improvement of family members’ academic skills; and 3) the generation of new role models.

Experience and Prevalence of Dental Caries in Migrant and Nonmigrant Low-SES Families' Children Aged 3 to 5 Years in Italy.

Dental caries is a public health problem in children and is more prevalent in low-socioeconomic-status groups. The aim of this study is to assess the association between migrant families and the prevalence of caries among young children in Italy. This is a cross-sectional study. In the age range of 3 to 5 years, a total of 266 migrant children and 301 nonmigrant children were examined in three Italian charity dental centers. All children had families with low SES. The dmft was determined by intraoral examination performed by six pediatric dentist specialists to assess their dental health. In this study, the prevalence of caries (71%) and the mean dmft (3.68; SD: 1.52) of migrant children were statistically significantly higher than the percentage (52%) and the mean dmft of the nonmigrant control group (3.10; SD: 1.65) with no differences between genders. For the migrant children, the mean (0.49; SD: 0.32) of restorations (filled teeth) was statistically significantly lower than that of nonmigrant children (1.20; SD: 0.48). This study highlights that dmft values and the prevalence of caries are higher in migrant children than in nonmigrant children. In addition, the control group shows a higher level of dental caries than the national mean.

Ultra-processed food consumption by children from a Pelotas Birth Cohort.

ABSTRACTOBJECTIVE Assessing the regular consumption of ultra-processed foods by children at 24 months of age from the 2015 Pelotas Birth Cohort and the main demographic, socioeconomic, and behavioral factors related to the consumption of these products.METHODS Population-based cohort in the city of Pelotas, RS, where 4,275 children were assessed at birth and 95.4% of them were followed up until 24 months of age. Food consumption was assessed by a questionnaire on regular consumption of ultra-processed foods, which collected information regarding sex, household income, maternal skin color, schooling level, and age, the child attending day care and having siblings, breastfeeding status, and obesity. The outcome was the sum of ultra-processed foods regularly consumed by a child. A multivariate Poisson regression analysis was used to calculate the association between the regular consumption of ultra-processed foods and exposure variables.RESULTS The mean number of ultra-processed foods consumed was 4.8 (SD = 2.3). The regular consumption of ultra-processed foods was positively associated with black skin color and having siblings, and negatively associated with household income and maternal schooling level and age.CONCLUSION The mean regular consumption of ultra-processed foods by children from the 2015 Pelotas Birth Cohort is high, which can negatively affect the children’s diet. The risk of consuming this kind of food was higher among children from families of lower socioeconomic status, whose mothers present lower education level, black skin color, and younger age.

A Qualitative Methods Approach to Reimagine Education-Related Parental Involvement among Low–Socioeconomic Status Families

Abstract Disparities in academic achievement have been well documented between low– and high–socioeconomic status (SES) students in the United States. Studies point to education-related parental involvement as a key factor in academic accomplishments, with higher parental involvement facilitating higher academic achievement. However, current definitions of parental involvement neglect interpretations of parental involvement held by low-SES parents. This work explored these definitions held by low-SES families through focus groups (n = 10) and individual interviews (n = 23) with parents of school-age children. Findings suggest that low-SES parents define parental involvement to include the vital role of siblings, limited communication with teachers unless behavioral or academic problems arise, and activating informal enrichment activities. Factors that hindered their involvement include having limited time for engaging in education-related activities and poor proficiency in educational materials. These findings suggest that the concept of parental involvement ought to be conceptualized in more nuanced ways to support the closure of the academic achievement gap between students from low- and high-SES families.

Promoting Racial/Ethnic Equity in Psychosocial Treatment Outcomes for Child and Adolescent Anxiety and Depression.

Anxiety and depression are the most prevalent and least treated pediatric mental health problems. Racial/ethnic minority youths face greater risks for developing anxiety and depression and experience higher burden as they are less likely to receive adequate mental health services for these conditions or to have their needs met. Further, standard evidence‐based interventions for youth anxiety and depression may show diminished effects with racial/ethnic minority youths and with families of lower socioeconomic status. While community‐level interventions to combat structural racism and reduce population‐level risk are sorely needed, many youths will continue to require acute treatment services for anxiety and depression and interventionists must understand how to bring equity to the forefront of care. In this review, we adopt a health system framework to examine racial/ethnic disparities in system‐, intervention‐, provider‐, and patient‐level factors for psychosocial treatment of pediatric anxiety and depression. Current evidence on disparities in access and in efficacy of psychosocial intervention for anxious and depressed youths is summarized, and we use our work in primary care as a case example of adapting an intervention to mitigate disparities and increase equity. We conclude with recommendations for disparity action targets at each level of the health system framework and provide example strategies for intervening on these mechanisms to improve the outcomes of racial/ethnic minority youths.

Speech and Reading Disorders Screening, and Problems in Structure and Function of Articulation Organs in Children in Mashhad City, Iran

Objectives: Investigating the prevalence of speech and language disorders and the contributing factors can help determine the best treatment options suited to the needs of these patients. So far, no comprehensive study has been conducted on screening speech and reading disorders and Problems in the Structure and Function of Articulation Organs (PSFAOs) in children in Mashhad City, Iran. This study aims to screen for these disorders and investigate the effects of demographic factors on such disorders. Methods: Via the stratified-cluster sampling method, 2770 native Persian-speaking children participated in this study, of whom 1381 were girls and 1389 were boys, ranging from preschool to the third grade (3 to 9 years old). After obtaining the demographic information, the PSFAOs screening was performed for all participants using a semi-structured questionnaire taken from Paul et al.’s report (2017). Screening for a grade of dysphonia was then carried out for children with suspected voice disorders using the grade, roughness, breathiness, asthenia, and strain test. Fluency of speech screening for children with suspected fluency disorders was performed using the stuttering severity instrument – fourth edition test, and screening of reading skills for school children was performed using the screening inventory reading test. Analytical analysis was performed via the Chi-square test between study variables, including disorders and other variables. Two types of logistic regression models were used. The data were analyzed using survey data analysis of the Stata software, version 14.1, and P<0.05 was considered significant. Results: The prevalence of articulation disorders, voice disorders, stuttering, PSFAOs, reading disorders, and multiple disorders (presence of two or more disorders per person) was 1.62%, 1.99%, 1.69%, 1.1%, 8.21%, and 14.89%, respectively. Descriptive analysis showed that the prevalence of articulation disorders, voice disorders, stuttering, and multiple disorders was higher in boys compared to girls (P=0.000), while the prevalence of reading disorders and PSFAOs was higher in girls (P=0.000). Furthermore, articulation disorders and reading disorders were more common in first-graders. The prevalence of voice disorders, stuttering, and PSFAOs were higher in the third graders. The logistic regression analysis showed that boys were more likely to develop speech and language disorders compared to girls (OR=1.3, P=0.01), and first-, second-, and third-graders were less likely to have such disorders when compared to preschoolers (OR=0.8, P=0.03). Discussion: Compared to previous studies, the different rates of prevalence of the disorders studied in this investigation are related to differences in their methodology, the number of samples, age, linguistic and cultural characteristics of the subjects, and individual factors. In this study, the prevalence of the studied disorders was higher in boys, first-graders, and children with families of 4 or more. The development of speech and language skills is different between genders; slower maturation of male brains seems to predispose them to slower development of speech skills. The lower prevalence in school-age children may be because these disorders gradually resolve during the early years of childhood. Moreover, low family socioeconomic status and family size may be the contributing factors to speech and language disorders.

Socioeconomic status differences in children's affective decision-making: The role of awareness in the Children's Gambling Task.

Future-oriented decision-making is an important adaptive behavior. In the present study, we examined whether decision-making varies as a function of socioeconomic status (SES) using the Children's Gambling task (CGT). We administered the CGT to 227 children (49% female, 48% low SES) between the ages of 5 and 7 years. After completing the CGT, we assessed children's knowledge of the reward/loss contingencies. Data analysis was conducted through multilevel modeling. Fluid intelligence, as measured by the Test of Nonverbal Intelligence, was included as a covariate in the analysis. Overall performance differed between SES groups. Children from middle/high-SES backgrounds learned to choose more from the deck with higher future reward. In contrast, children in the low-SES group did not act in a full future-oriented manner. No differences were found in the level of explicit understanding of the task reached by the two SES groups. Whereas middle/high-SES children with higher knowledge of the game performed better on the last blocks of the task in comparison with their same-SES peers with no understanding, low-SES children with higher explicit knowledge did not exhibit an improvement in their decision-making strategy in comparison with their same-SES low-awareness counterparts. Fluid intelligence did not predict CGT performance, suggesting that SES differences were not mediated by reasoning capabilities. The finding that children from low-SES families continued exhibiting an immediate reward-oriented strategy despite being aware of deck contingencies fits with (although speculatively) the evolutionary-developmental framework. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Exploring the intersectionality of family SES and gender with psychosocial, behavioural and environmental correlates of physical activity in Dutch adolescents: a cross-sectional study

BackgroundExamining the correlates of adolescent’s physical activity (PA) and how they may differ according to the intersection of gender and family socioeconomic status (SES) can support the development of tailored interventions to more effectively promote adolescents’ PA. This study explored how the associations between psychosocial, behavioural and environmental factors and adolescent’s PA differed according to gender and family SES.MethodsThis study used data from the Dutch Youth Health Survey 2015. Adolescents (n = 9068) aged 12–19 were included in the study. The associations between psychosocial, behavioural, and environmental factors and PA (days per week engaging in at least one hour of PA) were examined with multilevel linear regression analysis. Potential interactions between these correlates, gender and family SES were explored.ResultsOn average, adolescents engaged in at least one hour of PA for 4,2 days per week. Poor self-perceived health, low peer social support, and a weak connection with the environment were all associated with lower PA in adolescents. Daily smoking, cannabis use, risk of problematic gaming and social media use, as well as lack of daily consumption of fruit, vegetables, water and breakfast were associated with lower PA, whereas binge drinking was not. Interactions revealed that poor self-perceived health was associated with lower PA in adolescents from moderate- and high-SES families, but not in low-SES adolescents, whereas cannabis use was only associated with lower PA amongst low-SES adolescents. Low peer social support was associated with lower PA across all groups, but it was most strongly associated with lower PA amongst male adolescents from low-SES families than in other subgroups. Amongst low-SES males, low peer social support was associated with a 1.47 reduction in days engaging in sufficient PA, compared with a 0.69 reduction for high-SES males.ConclusionsThis study identified several psychosocial, behavioural and environmental factors that can be targeted to potentially increase adolescent’s PA. We also found that correlates of PA differed according to the intersection of gender and family SES. Our findings suggest that PA interventions should be tailored according to gender and SES to address the specific needs, barriers and facilitators of different subgroups.

USING A MACHINE LEARNING APPROACH TO EXPLORE NON-COGNITIVE FACTORS AFFECTING READING, MATHEMATICS, AND SCIENCE LITERACY IN CHINA AND THE UNITED STATES

Non-cognitive factors are considered critical aspects in shaping students' academic achievement. This study aims to analyze and explore the mechanisms of the influence of non-cognitive factors on 15-year-old students' abilities in China and the United States. Based on the Programme for International Student Assessment (PISA) 2018 education dataset, the Classification and Regression Tree (CART) model identifies and explains the factors. The study finds that there are 11 most influential common features in China and 9 in the United States. The two countries have 5 common features, the meta-cognition assess credibility, summarizing text ability, PISA test difficulty perception, science learning time, and school lessons numbers per week. Family economic status also impacts personal ability. Regarding subject characteristics, attitude towards failure is the determinant of reading and mathematics. Cooperation and competition among students help to improve mathematics and science. Furthermore, the comparison between the two countries concludes that self-awareness, family economic status, and school learning environment are critical to personal ability. The study concludes that it is necessary to foster a sense of healthy competition among students at the school level and provide more attention to students with low family socioeconomic status to improve their abilities. Keywords: machine learning approach; non-cognitive factors; PISA 2018; personal ability

Longitudinal relations between behavioral engagement and academic achievement: The moderating roles of socio-economic status and early achievement

This study investigated developmental trajectories of observationally coded engagement across the early elementary years and whether these trajectories were associated with children's academic achievement. Furthermore, we evaluated if these relations varied as a function of children's family socio-economic status and early reading and math skills. Data were collected from 301 children who were studied from kindergarten (Mage = 65.74 months; 49% boys) to 2nd grade. Children's behavioral engagement was observed in kindergarten, 1st, and 2nd grade. Reading and math skills were assessed via standardized tests in kindergarten and 2nd grade. Growth mixture models identified two classes of behavioral engagement: most children (87.0%) displayed relatively high behavioral engagement in the fall of kindergarten and decreased significantly across time (referred to below as high-decreasing class), and other children (13.0%) exhibited moderate behavioral engagement in the fall of kindergarten that was stable across time (referred to below as moderate-stable class). After controlling for academic skills in kindergarten and demographic variables (i.e., child age, sex, ethnicity, and family socio-economic status), children in the high-decreasing class displayed higher reading skills, but not math skills, than children in the moderate-stable class. Additional analyses revealed that differences in reading skills between the two classes were present only for children from low socio-economic status families or for children low in kindergarten reading skills. The findings suggest that economically or academically at-risk students might benefit more than their peers from high behavioral engagement.

Longitudinal associations among peer pressure, moral disengagement and cyberbullying perpetration in adolescents

Peer pressure is considered one of the top reasons adolescents participate in various risk behaviors, but the mechanism of peer pressure and adolescents' cyberbullying perpetration is unclear. The current study examined the longitudinal associations between peer pressure and adolescents' cyberbullying perpetration across three years, taking into account moral disengagement as a potential mediator and family socioeconomic status and gender as moderators of the associations. A sample of 2407 Chinese adolescents (Mage at baseline = 12.75 years) completed measurements of peer pressure, cyberbullying perpetration, moral disengagement, and family socioeconomic status at 3-time points with 1-year intervals. The results showed that peer pressure directly predicted subsequent cyberbullying perpetration. Cyberbullying perpetration at time 1 significantly predicted peer pressure and moral disengagement at time 2 only. Moral disengagement played a mediating role between peer pressure and cyberbullying perpetration across time. The relation between peer pressure and moral disengagement was more robust for adolescents with low family socioeconomic status than those with high family socioeconomic status. Compared to boys, girls who experienced high peer pressure at previous time points were more likely to have high peer pressure at subsequent time points. These findings provide a new scientific basis for the intervention of adolescents' cyberbullying perpetration.

Does Social and Economic Disadvantage Predict Lower Engagement with Parenting Interventions? An Integrative Analysis Using Individual Participant Data

There is a social gradient to the determinants of health; low socioeconomic status (SES) has been linked to reduced educational attainment and employment prospects, which in turn affect physical and mental wellbeing. One goal of preventive interventions, such as parenting programs, is to reduce these health inequalities by supporting families with difficulties that are often patterned by SES. Despite these intentions, a recent individual participant data (IPD) meta-analysis of the Incredible Years (IY) parenting program found no evidence for differential benefit by socioeconomic disadvantage (Gardner et al. in Public Health Resesearch 5, 1–144, 2017). However, it did not examine whether this was influenced by engagement in the intervention. Using intervention arm data from this pooled dataset (13 trials; N = 1078), we examined whether there was an SES gradient to intervention attendance (an indicator of engagement). We ran mixed-effects Poisson regression models to estimate incidence rate ratios (IRRs) for program attendance for each of five (binary) markers of SES: low income; unemployment; low education status; teen parent; and lone parent status. The multilevel structure of the data allowed for comparison of within-trial and between-trial effects, including tests for contextual effects. We found evidence that low SES was associated with reduced attendance at parenting programs—an 8–19% reduction depending on the SES marker. However, there was no evidence that this association is impacted by differences in SES composition between trials or by the attendance levels of higher-SES families. The findings underscore the importance of developing and prioritizing strategies that enable engagement in parenting interventions and encourage program attendance by low-SES families.

Development of cognitive control during adolescence: The integrative effects of family socioeconomic status and parenting behaviors

Cognitive control is of great interest to researchers and practitioners. The concurrent association between family socioeconomic status (SES) and adolescent cognitive control is well-documented. However, little is known about whether and how SES relates to individual differences in the development of adolescent cognitive control. The current four-year longitudinal investigation (N = 167, 13–14 years at Wave 1) used multi-source interference task performance (reaction time in interference correct trials minus neutral correct trials) and corresponding neural activities (blood oxygen level dependent contrast of interference versus neutral conditions) as measures of cognitive control. SES and parenting behaviors (warmth, monitoring) were measured through surveys. We examined direct and indirect effects of earlier SES on the development of cognitive control via parenting behaviors; the moderating effect of parenting also was explored. Results of latent growth modeling (LGM) revealed significant interactive effects between SES and parenting predicting behavioral and neural measures of cognitive control. Lower family SES was associated with poorer cognitive performance when coupled with low parental warmth. In contrast, higher family SES was associated with greater improvement in performance, as well as a higher intercept and steeper decrease in frontoparietal activation over time, when coupled with high parental monitoring. These findings extend prior cross-sectional evidence to show the moderating effect of the parenting environment on the potential effects of SES on developmental changes in adolescent cognitive control.

The Disproportionality of Poverty, Race, and Ethnicity With Child Maltreatment Reporting.

In this issue of Pediatrics, Rebbe et al1 used a population-based linked administrative data set to analyze data on nearly 4000 children <3 years of age who were hospitalized for child maltreatment. The study used diagnostic codes that were specific for, or suggestive of, maltreatment. The main findings identified that a disproportionate number of children with public health insurance (used as a proxy for poverty) were reported to Child Protective Services (CPS) as compared to children with private insurance, and this was true within each maternal race and ethnicity category. Findings regarding race and ethnicity showed that fewer children of Asian or Pacific islander mothers were reported to CPS as compared to White mothers, and children with American Indian mothers were more likely to have a diagnostic code specific (rather than suggestive) for maltreatment as comparted to all other groups. The authors interpreted these findings of disproportionality to indicate that children and families of lower socioeconomic status (SES) may be more closely scrutinized for maltreatment than those of higher SES, and that race and ethnicity is also a likely factor in CPS reporting and diagnosing abuse. The authors speculate that clinician implicit bias was a key driver behind the disproportionalities. They conclude that programs and policies are needed to prevent the inequitable way children receive protective interventions so that race and poverty “do not impact these crucial decision points regarding the intervention of child maltreatment.”Whether race and ethnicity or SES biases (implicit or otherwise) were the drivers behind the disproportionality cannot be ascertained directly from this data set because of key limitations. As stated by the authors, “it is difficult to ascertain from the available data whether the decision to assign a specific maltreatment code had more to do with the characteristics of the presenting medical problem or with racial bias.” It is highly likely, however, that biases are at play on many levels. Other studies support that underresourced families are disproportionality evaluated for maltreatment and that biased decision-making results in overinvestigations and reporting of abuse in children from Black, Hispanic, and American Indian families.2–7 Thus, efforts to tackle the impact of implicit and explicit biases on diagnosis and reporting of maltreatment are critical to decrease disparities that are adding to these disproportionalities.However, the impact of social factors on outcomes is not limited to bias at the time of diagnosis or decision-making to refer to CPS. Interacting social determinants of health such as racism, poverty, and classism, may cause some groups to be more structurally vulnerable to adverse health outcomes, including child maltreatment.8,9 Evidence indicates that the higher rates of identified and reported maltreatment among impoverished children in this study are likely influenced by real differences in rates of occurrence.3,10–15 Poverty is a known risk factor for child maltreatment,10–15 particularly in combination with other risk factors such as parental depression, substance use, and social isolation that are known to cotravel with poverty.13,16 Other low-resource factors also place children at increased risk. For example, for lower-income single parents to work, the parent may sometimes be forced to resort to less-than-optimal child care, which increases their children’s risk for maltreatment.11,13,17–19 Evidence shows that financial and social supports mitigate the increased risks of maltreatment for children in poverty.19–23 Conversely, decreased supports (ie, welfare benefits) are associated with increased rates of foster care placement (a proxy for maltreatment).24 This highlights why solutions to address maltreatment must also target economic inequities that deepen the problem.The disproportionalities of maltreatment diagnoses and reporting to CPS found in this study serve as a sentinel and likely reflect a combination of biases and true increased risk of maltreatment associated with poverty. It is critical that medical decision-makers do not conflate lower SES status or race and ethnicity with assumptions of maltreatment, because this implicit conflation is causing direct harm and further deepening existing disproportionalities as well as disparities. We must also recognize that underresourced and distressed families may have needs and stressors that contribute to a child’s increased risk of negative outcomes, including maltreatment. The effects of compounded bias, oppression, injustice, and resource scarcity for certain communities are, unfortunately, enduring problems. A public health approach is required to address these injustices at the community-level, along with simultaneous work toward behavior change at the individual level to mitigate impacts of bias, and policy change at the institutional level to reduce the harms of unjust systems. Strategies for opening our eyes to our own biases, while not turning a blind eye to the risk to children that poverty brings, are critical to achieve equitable care for all.9,25