Low-income African American Children Research Articles

A home visit program for low-income African American children with asthma: Caregivers' perception of asthma triggers and a gap in action

PurposeThe goals are to gauge caregivers' knowledge of at-home asthma triggers and identify the areas on which educational campaigns can focus to alleviate a child's asthma symptoms. Design and methodsFamilies with children with moderate to severe asthmatic symptoms who had been recently hospitalized or in the emergency room were invited to participate in a home visit program. As part of the home visit, caregivers of the asthmatic children were asked a series of questions on asthma triggers and the measures for eliminating the triggers (N = 218). ResultsFindings show a gap between caregivers' perception of asthma triggers and the actions to mitigate or avoid such triggers. ConclusionsOverall findings show that home environments were suboptimal for the management and control of child asthma conditions. Knowledge about home triggers as well as the actions and efforts by caregivers and landlords to mitigate these was found to be inadequate. Even when caregivers are aware of the presence of at-home triggers, actions to minimize exposure to the trigger do not always follow due to a lack of power, resource, and knowledge. Practice implicationsThe findings raise the need for additional research to investigate the reasons for the lack of actions, advocacy for low-income families to live in a healthy environment, continued education and empowerment, and patient/caregiver-doctor partnership. Additionally, the provision of community support through community advocacy and training of culturally competent healthcare providers are needed for the successful management of pediatric asthma among African American children.

We Need a New Approach to Prevent Obesity in Low-Income Minority Populations.

* Abbreviations: COPTR — : Childhood Obesity Prevention and Treatment Research Consortium CPP — : community policy and program CPP-Strat — : community policy and program created to assess either nutrition or physical activity strategy GEMS — : Girls’ Health Enrichment Multi-site Studies HCS — : Healthy Communities Study In the last 2 decades, the National Institutes of Health invested in 2 major multicenter trials aimed at the prevention of obesity in high-risk populations of low-income Hispanic and African American children.1 The trials were the Childhood Obesity Prevention and Treatment Research Consortium (COPTR) and the Girls’ Health Enrichment Multi-site Studies (GEMS). Despite intensive, state-of-the-art, and often creative interventions conducted by seasoned investigators, all 5 of the studies considered below failed to alter the trajectory of weight gain in their participants compared with controls. In this issue of Pediatrics , Moore et al2 describe the most recent of the COPTR studies. This study, conducted in Cleveland, Ohio, is 1 of 4 randomized controlled intervention trials, 2 of which have already been published. In this trial, 360 predominantly African American middle school children (mean age 11.6 years) and their parents were randomly assigned to a HealthyChange intervention, which relied on cognitive behavioral and motivational interviewing strategies that focused on goal setting, problem solving, self-monitoring, and relapse prevention. The control group was a SystemChange intervention that sought to establish family routines, restructured to develop new healthy habits. Both interventions focused on improving diet, physical activity, sleep and stress management, and reducing sedentary behavior. Both interventions included intensive engagement through 25 small-group sessions in the first year, alternating face-to-face and individualized phone sessions in year 2, and 4 face-to-face sessions and 8 individualized phone sessions in year 3. At the end of the 3-year intervention, 90% of enrolled participants remained in the study. No significant differences were observed in annual changes of BMI, waist circumference, or triceps skinfold thickness. Furthermore, no significant differences were observed in diet, physical activity measured by accelerometry, sleep, perceived stress, or cardiometabolic factors. In 2 other COPTR studies that included randomized intensive obesity interventions in low-income, … Address correspondence to William H. Dietz, MD, PhD, Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, George Washington University, Room 319, 950 New Hampshire Ave NW, Washington, DC 20052. E-mail: bdietz{at}email.gwu.edu

Developmental Transactions Between Self-Regulation and Academic Achievement Among Low-Income African American and Latino Children.

This study examined the development of emerging self-regulation (SR) skills across the preschool years and relations to academic achievement in kindergarten and first grade. SR skills of 403 low-income African American and Latino children were measured at 2&1/2, 3&1/2, and 5years (kindergarten). Reading and math skills were measured at 5 and 6years (first grade) using the Woodcock-Johnson. Transactional relations between SR skills and achievement outcomes were estimated with latent difference score models. Increases in set shifting predicted prospective increases in reading, but not math scores. Increases in simple response inhibition predicted prospective increases in math, but not reading scores. Application of these findings to early intervention programming and needed supports for school readiness and achievement are discussed.

Behavioral Self-Regulation, Early Academic Achievement, and the Effectiveness of Urban Schools for Low-Income Ethnic Minority Children.

The independent and joint associations between child behavioral self-regulation ability and school effectiveness in relation to academic achievement were examined in a sample of low-income African American (n=132) and Latino (n=198) children attending kindergarten and first grade across a large metropolitan area. Child behavioral self-regulation and school effectiveness were positively associated with both reading and mathematics performance. School effectiveness moderated the effect of behavioral self-regulation on reading but not math achievement. Lower child behavioral self-regulation during early elementary school was associated with lower reading achievement the following year but only among children attending less effective schools. Behavioral self-regulation was not related to reading achievement among children attending more effective schools. Implications of these findings for policies addressing disparities in early academic achievement are discussed.

Increasing fruit and vegetable intake in low-income minority children: African American mothers as experts on effective strategies and barriers to FV.

Objective: Eating habits and taste preferences begin to develop early in life, yet little is known about self-efficacy and struggles related to promoting FV among young children directly from the maternal perspective. Poor diet quality, including low FV consumption, is associated with race/ ethnicity- and income-based health disparities in the U.S., with low-income African Americans reporting the lowest intakes. Thus, the purpose of this study was to explore parenting strategies that are perceived as effective for encouraging FV consumption among low-income African American mothers of young children in order to inform future interventions for this at-risk population. Methods: Mothers of 3 to 5-year-old children from two Head Start programs in a southeastern state of the U.S. were recruited for focus group participation. Focus group transcripts were analyzed using a content analysis to identify main themes in relation to perceived effective practices, and key barriers and facilitators to encouraging children’s FV consumption. Results: Accessibility strategies were uniquely perceived as effective for encouraging fruit. Negotiating/coaxing, making available, and using rules were perceived as effective and unique practices for vegetables. Child openness and maternal FV preferences facilitated maternal efforts to encourage FV consumption. Mothers identified three primary barriers to FV consumption: 1) child’s “difficult” temperament; 2) negative family influences, and 3) low maternal FV preferences/modeling. Conclusions: Low-income African American mothers utilize a large number and variety of strategies to encourage children’s FV intake. Mothers themselves can serve as a key source of tips/strategies for each other’s social and educational support. Future research should examine specific strategies that emerged in the current study in relation to actual FV consumption in lowincome African American children

A Youth-Leader Program in Baltimore City Recreation Centers: Lessons Learned and Applications

Peer-led interventions may be an effective means of addressing the childhood obesity epidemic; however, few studies have looked at the long-term sustainability of such programs. As part of a multilevel obesity prevention intervention, B'More Healthy Communities for Kids, 16 Baltimore college students were trained as youth-leaders (YLs) to deliver a skill-based nutrition curriculum to low-income African American children (10-14 years old). In April 2015, formative research was used to inform sustainability of the YL program in recreation centers. In-depth interviews were conducted with recreation center directors ( n = 4) and the YLs ( n = 16). Two focus groups were conducted with YLs ( n = 7) and community youth-advocates ( n = 10). Barriers to this program included difficulties with transportation, time constraints, and recruiting youth. Lessons learned indicated that improving trainings and incentives to youth were identified as essential strategies to foster continuity of the youth-led program and capacity building. High school students living close to the centers were identified as potential candidates to lead the program. Based on our findings, the initial intervention will be expanded into a sustainable model for implementation, using a train-the-trainer approach to empower community youth to be change agents of the food environment and role models.

Neighborhood and Parental Influences on Diet and Physical Activity Behaviors in Young Low-Income Pediatric Patients.

This study explores the relationship between neighborhood characteristics and caregiver preferences for establishing diet and physical activity behaviors among low-income African American and Hispanic young children (2-5 years). Primary caregivers of young children were recruited from 2 urban pediatric clinics to participate in focus groups (n = 33). Thematic analysis of transcripts identified 3 themes: neighborhood constraints on desired behaviors, caregivers' strategies in response to neighborhoods, and caregivers' sense of agency in the face of neighborhood constraints. This study elucidates the dynamic relationship between neighborhoods and caregiver preferences, their interrelated impacts on establishment of diet and physical activity behaviors among young children, and the important role of caregiver agency in establishing behaviors among young children. To effectively address obesity disparities among young children, primary care behavioral interventions must leverage and support such resilient caregiver responses to neighborhood constraints in order to optimally address racial/ethnic and socioeconomic disparities in obesity among young children.

Elementary School Difficulties of Low-Income Latino and African American Youth: The Role of Geographic Context

ABSTRACT:Do the geographic contexts in which disadvantaged children are raised influence whether they have difficulties in elementary school? We address this question by estimating Cox proportional hazard models with instrumental variable measures of context, using data for 410 low-income Latino and African American children who lived in Denver public housing before age six. The Denver Housing Authority’s procedure for allocating families to dwellings mimics random assignment, thus offering an unusual natural experiment for measuring context effects isolated from geographic selection bias. We find that several socioeconomic and demographic contextual indicators are statistically and substantively important predictors of low-income Latino and African American children’s difficulties in elementary school, though sometimes in nonlinear and interactive ways. Generally, the hazard of being assigned to special education classes, suspended, or forced to repeat a grade is greater in neighborhoods with higher occupational prestige and percentages of immigrants and lower in those with higher percentages of African American residents.

Neighbourhood ethnic composition and outcomes for low-income Latino and African American children

The paper investigates the impact of ethnic segregation on the life chances of low-income African American and Latino children, focusing on whether it is the ethnic composition of the neighbourhood per se that matters or other, correlated aspects of the residential environment. The approach links the consequences of segregation and neighbourhood effects literatures by arguing that metropolitan segregation forces directly shape children’s intra-neighbourhood ethnic exposure and indirectly shape their exposure to non-ethnic aspects of neighbourhood. Associations between a wide range of neighbourhood characteristics and children’s health, exposure to and engaging in violence, educational and fertility outcomes are quantified using a natural experiment, thereby permitting valid causal inferences. Data analysed come from a retrospective survey of Denver (CO) Housing Authority (DHA) residents. The analysis avoids parental geographic selection bias because DHA’s assignment of households to neighbourhoods mimics a random process. Logit models stratified by ethnicity show that growing up amid concentrations of African American residents is associated with a variety of adverse outcomes for low-income Latino and (especially) African American children, though outcomes associated with concentrations of Latino residents are more mixed. Virtually all of the negative associations disappear, however, when other aspects of the residential context are controlled, and several positive ones persist. The adverse developmental consequences of ethnic segregation appear to be generated primarily in Denver by concentrating minority children in neighbourhoods with higher rates of property crime and lower occupational prestige.

Social interactions and children with asthma.

This article reviews the literature on the effects of living in a disenfranchised community for low-income African American children who have asthma. The review focuses on social integration, social network, interactions with parents, and limited cultural resources, which lead to negative health outcomes among these children.

Maternal Perceptions Related to Eating and Obesity Risk Among Low-Income African American Preschoolers.

Objectives Health disparities are prevalent in the U.S., with low-income African American children suffering from high rates of obesity and related conditions. Better understanding of parental attitudes and barriers related to healthy eating and obesity risk is needed to suggest more effective intervention foci for this at-risk population. Methods African American caregivers of 3-5year old children were recruited for focus groups and a questionnaire completion from two Head Start programs in a southeastern state of the U.S. The Social Cognitive Theory was utilized to develop a focus group guide. Focus group recordings were transcribed verbatim and analyzed using the comparative content analysis. Results Eight focus groups (all participants were mothers) yielded the following main themes: (1) general nutrition knowledge but common misconceptions about foods/beverages; (2) beliefs that meals have to include meat and starch and be home-cooked to be healthy; (3) desire to feed children better than their own parents; (4) lack of family support and child pickiness perceived as the greatest barriers to healthy eating; (5) awareness of family history of diseases; and (6) low concern about children's current diet and weight status. Over 25% of mothers underestimated their child weight status. Conclusions Our findings highlight the importance of understanding maternal perspectives related to food, eating, and weight among low-income African American mothers of preschoolers. Nutrition educators should be aware of misconceptions and recognize that mothers might not perceive diet quality in early childhood as having strong impact on the child's future health and/or obesity risks.

Angus Deaton , The Great Escape : Health, Wealth, and the Origins of Inequality , Princeton (N. J.), Princeton University Press, 2013, XV-360 p.

James J. heCKmAn, Giving Kids a Fair Chance, Cambridge, Ma., The MIT Press, Boston Review Books, 2013, 137 p.Over the last decade, Nobel Prize-winning economist James Heckman has produced a fundamental set of writings on the economics of early childhood. Heckman argues that many of the economic, social and health inequalities currently seen in the US are rooted in the early childhood period and that the strong intergenerational transmission of advantage and disadvantage found in the country today means that birth is becoming fate (p. 3). Early childhood, then, is precisely the period in which to impact on disadvantaged trajectories, as many cognitive and socio-emotional skills key to future educational and economic success are being developed during this period and are therefore at their most malleable. In the first section of the book, Heckman puts forward his argument on the need for intervention in early childhood to break the vicious circle of disadvantage that is polarizing the US population. Ten experts from a number of different fields ranging from economics to genetics to sociology then respond to his main argument, giving the book an interdisciplinary perspective on a highly sensitive political subject on which there is not always consensus across disciplines. The last word is Heckman's; in the closing section of the book he briefly replies to these authors.The book is an excellent introduction to Heckman's thinking on early childhood. The major thrust of his argument is summarized in the first section: social policy can fill the growing gap between rich and poor and should integrate three major research findings: 1) skills (such as motivation, attention and self-control) are just as important as cognitive skills and similarly predict social outcomes; 2) both cognitive and non-cognitive skills are developed very early in life, and once disparities in these skills appear they are hard to remedy; and 3) contrary to the claims of genetic determinism, intervention in early life can produce positive, long-lasting results. Those positive outcomes not only benefit individuals who participate in early childhood programs but have wider, spillover effects on children's families and communities, in that they foster a more skilled workforce, reduce the need for welfare and social services, decrease the risk of teenage pregnancy, family breakdown, etc.Much of Heckman's work is a contribution on this last point, particularly his studies of the Perry Preschool Project, extensively quoted in the book. The Perry Project was an intensive pre-school program conducted with 58 low-income African American children in Ypsilanti, Michigan, from 1962 to 1967. It consisted of a two-and-a-half hour daily schoolroom session for the children and one 90-minute weekly home visit from the teacher with the children's parents. This was continued for two years. The project children and a control group were followed to age 40. According to Heckman, the Perry Preschool Project consistently shows positive outcomes for program children: while the initial IQ increase receded in the 4 years following intervention, the positive effects on non-cognitive skills and social outcomes persisted: participating children achieved higher educational qualifications, earned higher wages in adulthood, and were less likely to be on welfare or in prison. …

Marginal mean models for zero-inflated count data.

Zero-inflated regression models have emerged as a popular tool within the parametric framework to characterize count data with excess zeros. Despite their increasing popularity, much of the literature on real applications of these models has centered around the latent class formulation where the mean response of the so-called at-risk or susceptible population and the susceptibility probability are both related to covariates. While this formulation in some instances provides an interesting representation of the data, it often fails to produce easily interpretable covariate effects on the overall mean response. In this article, we propose two approaches that circumvent this limitation. The first approach consists of estimating the effect of covariates on the overall mean from the assumed latent class models, while the second approach formulates a model that directly relates the overall mean to covariates. Our results are illustrated by extensive numerical simulations and an application to an oral health study on low income African-American children, where the overall mean model is used to evaluate the effect of sugar consumption on caries indices.

Tooth Surface Level Caries Progression in the Primary Dentition among Preschool Children

The objective of this paper is to describe primary tooth surface level caries progression, over 2 years, based on the severity of the caries lesions. Data were collected from 790 low-income African-American preschool children in Detroit, Mich., USA. The caregivers of the children (aged 0-5 years) completed interviews and the dyad of child-caregiver completed dental examinations in 2002-2004 (baseline) and in 2004-2005 (follow-up). Caries were measured using the International Caries Detection and Assessment System (ICDAS). The caries status of tooth surfaces was classified into initial (ICDAS 1-2), moderate (ICDAS 3-4) and extensive (ICDAS 5-6) stages. Counts of tooth surfaces with progression, by baseline caries severity level, were used to compute rate ratios (RRs) relative to sound stages. RRs were also computed for type of tooth surfaces and frequency of intake of soda consumption at baseline. After adjusting for confounders, caries progression was more likely to occur in tooth surfaces with any baseline caries relative to sound surfaces. For surfaces with initial caries, the rate of progression to moderate caries was 9.6 times higher than that of sound surfaces. Surfaces with initial and moderate caries progressed to extensive caries 6.1 and 20.6 times, respectively, relative to sound surfaces. Baseline soda consumption was not associated with the RR of caries progression. In conclusion, the staging of caries identifies different progression risks and significant emphasis should be placed on secondary prevention of initial lesions as well as on primary prevention.

“So we would all help pitch in:” The family literacy practices of low-income African American mothers of preschoolers

The development of emergent literacy skills are important for the development of later literacy competencies and affect school readiness. Quantitative researchers document race- and social class-based disparities in emergent literacy competence between low-income African American and middle-income White children. Some researchers suggest that deficits in parenting practices account for limited literacy skills among low-income African American children. A small body of qualitative research on low-income African American families finds that despite economic challenges, some African American families were actively engaged in promoting child literacy development. Using qualitative interviews that emphasize family strengths, we add to this small body of research to highlight positive family practices obscured in many quantitative analyses that concentrate on family shortcomings. Specifically, we examine in-home literacy practices and child literacy development with a sample of low-income African American mothers (families) of preschoolers. Key findings include identification of various literacy activities promoting child literacy development and inclusion of multiple family members assisting in literacy activities. These findings add to substantive discussions of emergent literacy and resilience. Insights from the qualitative interviews also provide culturally-sensitive recommendations to childhood educators and speech-language pathologists (SLP) who work with low-income African American families and children.Learning outcomes: Reader should recognize that (1) there is not a ‘right’ phenotype and therefore not a right form of environmental input and (2) that context matters (at both the level of the cell and the individual organism).

Short Term outcomes of a Faith-based Obesity Attenuation and Prevention Program for Low Income African American Children: CHHIL Feasibility and Efficacy Study

Background: The CHHIL is a faith-based, culturally tailored and multi-level obesity attenuation and prevention program for African American (AA) children and adolescents in low-income church community. The study objective is to test the feasibility and efficacy of 8 weeks CHHIL intervention. Methods: This is a sequential mixed methods study design, examining the feasibility and efficacy of 8 weeks CHHIL intervention conducted at a low income neighborhood AA church. All sessions were conducted at the AA church, after Sunday services. Parents and children separately attended seven weekly group sessions focused on lifestyle modification. Participants: 1) an AA church member; 2) age 8-17 years; 3) Child BMI of 85%-95% or parent with BMI ≥ 25 or family history of type 2 diabetes. Eleven families (child and at least one parent/guardian) were recruited. At the baseline and then every week for 7 weeks children’s nutrition, physical activity (PA) and anthropometric information was obtained. Primary outcomes were changes in dietary intake/patterns and BMI at the end of 8-weeks CHHIL program. Changes in outcome measures were assessed using paired samples t-tests, ANOVA and non-parametric tests. Results: Of the 11 children and adolescents who enrolled, seven (63%) completed the 8-weeks program. Overall there was a trend among the children and adolescents to decrease total calories (kcals), protein, and carbohydrates consumed overtime. Participants consumed significantly lower levels of sodium from baseline to end of the program (P<0.001). At the end of 8 sessions (7 weeks), no significant change in BMI and other anthropometric parameters was seen at the end of the program. Conclusion: The CHHIL program may be a promising option for health behaviors changes and thus changes in weight for church-based ethnic minorities. However trend towards improvements in dietary behaviors were observed, no impact on anthropometric measures were seen requiring further research with longer program duration. With increasing burden of health disparities, childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded within health, education and care systems and achieve long term sustainable impacts.

Stakeholder perspectives on barriers for healthy living for low-income african american families.

Background: Childhood obesity is a growing problem for children in the United States, especially for children from low-income, African American families.Objective: The purpose of this qualitative study was to understand facilitators and barriers to engaging in healthy lifestyles faced by low-income African American children and their families.Methods: This qualitative study used semi-structured focus group interviews with eight African American children clinically identified as overweight or obese (BMI ≥ 85) and their parents. An expert panel provided insights in developing culturally appropriate intervention strategies.Results: Child and parent focus group analysis revealed 11 barriers and no definitive facilitators for healthy eating and lifestyles. Parents reported confusion regarding what constitutes nutritional eating, varying needs of family members in terms of issues with weight, and difficulty in engaging the family in appropriate and safe physical activities; to name a few themes. Community experts independently suggested that nutritional information is confusing and, often, contradictory. Additionally, they recommended simple messaging and practical interventions such as helping with shopping lists, meal planning, and identifying simple and inexpensive physical activities.Conclusion: Childhood obesity in the context of low-resource families is a complex problem with no simple solutions. Culturally sensitive and family informed interventions are needed to support low-income African American families in dealing with childhood obesity.

Dental caries development among African American children: results from a 4-year longitudinal study.

To examine dental caries development and caries risk factors among preschool African American children from low-income families in Detroit, Michigan, over a 4-year window. Data came from a representative sample of 1021 children (0-5 years) and their caregivers in Detroit. The baseline participants in 2002-2003 (W1) were re-examined in 2004-2005 (W2) and 2007 (W3). Caries was measured using the International Caries Detection and Assessment System. Bivariate and multivariate analyses for repeated data were conducted to explore associations between caries increment outcomes and demographics, access to dental care, oral health-related behaviours, and social and physical environments. The mean number of new noncavitated caries lesions (NCCL) was 2.8 between W1 and W2 and 2.6 between W2 and W3, while the mean number of new cavitated caries lesions (CCL) was 2.0 and 2.0, respectively, during the same time periods. In younger children (<3 years old in W1), higher number of new NCCL than new CCL was observed in both W1-W2 and W2-W3. The risk of new NCCL was associated with child's soda intake and caregiver's age. For the risk of new CCL, significant risk factors included baseline NCCL, baseline CCL, as well as child's age. Baseline caries and child's soda intake were also associated with the risk of developing new decayed, missing and filled tooth surfaces. Higher number of new NCCL relative to CCL was developed among low-income African American children during early childhood. New caries development was associated with baseline caries and child's soda intake.

Child Abuse, Social Support, and Social Functioning in African American Children

This study examined the relationship among child abuse (physical, emotional, and sexual), social support from friends and family, and social functioning in a sample of low-income African American children (N = 152). With the exception of the association between sexual abuse and peer support, all of the correlations among study variables were significant. The relationship between child physical and emotional abuse and social functioning were mediated by both family and peer support; however, only family (not peer) support was a significant mediator in the sexual abuse-social functioning link. Additionally, there was no difference found in the strength of mediation via family support versus peer support. Results suggest that mental health professionals should inquire about and attempt to increase children’s levels of social support from family and peers when working with abused youth in order to promote healthy psychological and psychosocial outcomes.

B'More Healthy Communities for Kids: design of a multi-level intervention for obesity prevention for low-income African American children.

BackgroundChildhood obesity rates in the U.S. have reached epidemic proportions, and an urgent need remains to identify evidence-based strategies for prevention and treatment. Multi-level, multi-component interventions are needed due to the multi-factorial nature of obesity, and its proven links to both the social and built environment. However, there are huge gaps in the literature related to doing these kinds of interventions among low-income, urban, minority groups.MethodsThe B’More Healthy Communities for Kids (BHCK) intervention is a multi-level, multi-component intervention, targeting low-income African American youth ages 10–14 and their families in Baltimore, Maryland. This intervention prevents childhood obesity by working at multiple levels of the food and social environments to increase access to, demand for, and consumption of healthier foods. BHCK works to create systems-level change by partnering with city policy-makers, multiple levels of the food environment (wholesalers, corner stores, carryout restaurants), and the social environment (peers and families). In addition, extensive evaluation will be conducted at each level of the intervention to assess intervention effectiveness via both process and impact measures.DiscussionThis project is novel in multiple ways, including: the inclusion of stakeholders at multiple levels (policy, institutional, and at multiple levels of the food system); that it uses novel computational modeling methodologies to engage policy makers and guide informed decisions of intervention effectiveness; it emphasizes both the built environment (intervening with food sources) and the social environment (intervening with families and peers). The design of the intervention and the evaluation plan of the BHCK project are documented here.Trial registrationNCT02181010 (July 2, 2014).