Rural African American Children Research Articles

Protective Prevention Effects on the Association of Poverty With Brain Development

This study was designed to determine whether a preventive intervention focused on enhancing supportive parenting could ameliorate the association between exposure to poverty and brain development in low socioeconomic status African American individuals from the rural South. To determine whether participation in an efficacious prevention program designed to enhance supportive parenting for rural African American children will ameliorate the association between living in poverty and reduced hippocampal and amygdalar volumes in adulthood. In the rural southeastern United States, African American parents and their 11-year-old children were assigned randomly to the Strong African American Families randomized prevention trial or to a control condition. Parents provided data used to calculate income-to-needs ratios when children were aged 11 to 13 years and 16 to 18 years. When the participants were aged 25 years, hippocampal and amygdalar volumes were measured using magnetic resonance imaging. Household poverty was measured by income-to-needs ratios. Young adults' whole hippocampal, dentate gyrus, and CA3 hippocampal subfields as well as amygdalar volumes were assessed using magnetic resonance imaging. Of the 667 participants in the Strong African American Families randomized prevention trial, 119 right-handed African American individuals aged 25 years living in rural areas were recruited. Years lived in poverty across ages 11 to 18 years forecasted diminished left dentate gyrus (simple slope, -14.20; standard error, 5.22; P = .008) and CA3 (simple slope, -6.42; standard error, 2.42; P = .009) hippocampal subfields and left amygdalar (simple slope, -34.62; standard error, 12.74; P = .008) volumes among young adults in the control condition (mean [SD] time, 2.04 [1.88] years) but not among those who participated in the Strong African American Families program (mean [SD] time, 2.61 [1.77] years). In this study, we described how participation in a randomized clinical trial designed to enhance supportive parenting ameliorated the association of years lived in poverty with left dentate gyrus and CA3 hippocampal subfields and left amygdalar volumes. These findings are consistent with a possible role for supportive parenting and suggest a strategy for narrowing social disparities.

Geographic Variation in Mortality Among Children and Adolescents Diagnosed With Cancer in Tennessee

Cancer is one of the leading causes of death among children in the United States. Previous research has examined geographic variation in cancer incidence and survival, but the geographic variation in mortality among children and adolescents is not as well understood. The purpose of this study was to investigate geographic variation by race in mortality among children and adolescents diagnosed with cancer in Tennessee. Using an innovative combination of spatial and nonspatial analysis techniques with data from the 2004-2011 Tennessee Cancer Registry, pediatric deaths were mapped and the effect of race on the proximity to rural areas and clusters of mortality were explored with multivariate regressions. The findings revealed that African American children and adolescents in Tennessee were more likely than their counterparts of other races to reside in rural areas with close proximity to mortality clusters of children and adolescents with a cancer. Findings have clinical implications for pediatric oncology nurses regarding the delivery of supportive care at end of life for rural African American children and adolescents.

Accuracy of Self-reported Height and Weight in low-income, Rural African American Children

Objective: To validate self-report anthropometric data in a sample of low-income, rural African American youth. Methods: Ninety-two youth, 10.16 ± 0.85 years of age, were recruited from one school in a rural area of the southeast U.S. Youth were asked to self-report height and weight prior to having their height and weight measurements recorded by trained researchers. Body Mass Index (BMI) was calculated and BMI percentile rank (BMIpct) were used to classify adolescents as non-overweight/obese or overweight/obesity. Differences between measured and self-reported values were assessed using paired t-tests, and differences between weight categories were examined with independent t-tests. Agreement between classification of overweight/obesity by self-report and measured values was assessed using Chi Square. Results: Self-report and measured weight, but not height, differed significantly with the self-reported weight value being 3.1 kg lower than the measured value. Neither height nor weight differed between methods for nonoverweight/ obese youth. For overweight/obese youth, height values were similar but weight values differed between methods (p<0.001) with overweight/obese youth under-reporting their weight to a greater extent than nonoverweight/ obese youth (-8.3 + 9.9 vs. -0.74 + 5.0; p<0.001). The prevalence of overweight/obesity from measured values was 31.5% compared to 30.4% from self-reported values. However, the sensitively was low (58.6%) because of overweight/obese youth’s inability to accurately self-report their weight. Conclusion: The use of self-reported heights and weights for deriving estimates of overweight/obesity rates in lower-income, rural African American youth was not supported by this study

Accuracy of Self-reported Height and Weight in low-income, Rural African American Children

Objective: To validate self-report anthropometric data in a sample of low-income, rural African American youth. Methods: Ninety-two youth, 10.16 ± 0.85 years of age, were recruited from one school in a rural area of the southeast U.S. Youth were asked to self-report height and weight prior to having their height and weight measurements recorded by trained researchers. Body Mass Index (BMI) was calculated and BMI percentile rank (BMIpct) were used to classify adolescents as non-overweight/obese or overweight/obesity. Differences between measured and self-reported values were assessed using paired t-tests, and differences between weight categories were examined with independent t-tests. Agreement between classification of overweight/obesity by self-report and measured values was assessed using Chi Square. Results: Self-report and measured weight, but not height, differed significantly with the self-reported weight value being 3.1 kg lower than the measured value. Neither height nor weight differed between methods for nonoverweight/ obese youth. For overweight/obese youth, height values were similar but weight values differed between methods (p<0.001) with overweight/obese youth under-reporting their weight to a greater extent than nonoverweight/ obese youth (-8.3 + 9.9 vs. -0.74 + 5.0; p<0.001). The prevalence of overweight/obesity from measured values was 31.5% compared to 30.4% from self-reported values. However, the sensitively was low (58.6%) because of overweight/obese youth’s inability to accurately self-report their weight. Conclusion: The use of self-reported heights and weights for deriving estimates of overweight/obesity rates in lower-income, rural African American youth was not supported by this study

Designing a culturally sensitive intervention to promote healthy eating and physical activity behavior in children and their parents in rural Louisiana communities

Rural African American children are experiencing a high prevalence of overweight and obesity. Formative research guided the design of a culturally sensitive intervention that would assist families in the Lower Mississippi Delta in adopting eating and physical activity patterns consistent with the Dietary Guidelines for Americans, 2005 (DGA, 2005), and thereby reducing weight gain and associated risk factors for obesity‐related chronic diseases. A community advisory committee, focus groups, and data from previous research in this region contributed to information relative to ethnic/cultural characteristics, norms, values, beliefs, and behavioral patterns of the target population. Using the surface and deep‐structure framework, researchers identified content and a variety of strategies to form the culturally sensitive intervention. The main surface‐structure intervention component included modifying the family obesity prevention program, WE CAN! (Ways to Enhance Children's Activity and Nutrition) to reflect the ethnicity, reading level, food and physical activity lifestyles of the participants. Maintaining strong families was identified as a dominant deep‐surface component. Reflections on the historical African American family provide motivation for recommended behavioral changes. Classes included in the intervention are on healthy eating and physical activity, stages of change, goal setting, self‐efficacy, and positive parental feeding methods. Demonstrations for modifying traditional and Cajun‐influenced recipes to adhere to DGA, 2005 are important elements of the intervention. Further research will examine the efficacy of using a culturally sensitive intervention to assist families in promoting healthy eating and physical activity behavior.

Dietary, Physical Activity, and Lifestyle Behaviors of Rural African American South Carolina Children

Overweight and obese children continue to be a growing problem, and differences exist, especially among racial and ethnic groups. Even though a poor diet and lack of physical activity are attributable factors to being overweight among children, indications exists that geographic location may also be important. In rural areas in the United States, childhood obesity is often higher than the national average. This study analyzed dietary, physical, activity, and lifestyle behaviors of rural African American children and their risk for becoming overweight. This study is a cross-sectional convenience sample of 98 students from a rural county in South Carolina in 2002. Findings showed rural female children were significantly more likely than rural male children to engage in physical activity for at least 20 minutes per day (odds ratio, 5.57; p = .0056). Given the increase in the prevalence of obesity especially among minority populations, the need exists to develop culturally appropriate nutrition and exercise interventions to assistchildren in a healthy weight loss attempt. Increased prevalence of obesity and other diseases among African Americans warrants aggressive interventions to reduce risk factors in this vulnerable population.

Examining Perceptions About Mental Health Care and Help-Seeking Among Rural African American Families of Adolescents

Rural African American children living in poverty have a higher prevalence rate of mental health disorders than their urban counterparts. While access to mental health services is lacking in resource scarce rural communities, African American rural residents may also be the most likely to confront significant barriers to care and help-seeking. Studies of mental health help-seeking behavior among rural families are rare, even rarer are studies of African Americans living in these areas. To address this gap, the current study examined perceptions about help-seeking for adolescents with mental health problems among rural African American families. Data were obtained from African American mothers in rural Georgia to assess their perceptions of the mental health service system, help-seeking processes, and service experiences. A mixed-method approach was implemented, integrating a quantitative survey (n=163) with qualitative interviews (subsample n=21). Most of the mothers expressed confidence in mental health care providers' to help. Preferred sources of support, however, were family, church, and schools. Community stigma towards children with mental health problems and their families was a frequently endorsed perceived barrier to help-seeking. Although cultural mistrust was one of the two most frequently endorsed barriers in the survey, it did not emerge as a universal barrier to help-seeking for the mothers in this sample. Implications for research, policy, and practice include addressing family concerns about stigma, preferences for informal support and non-specialty services in addressing adolescents' mental health problems, and building community resources to enable all youth to participate in community life.

Protective Longitudinal Paths Linking Child Competence to Behavioral Problems Among African American Siblings

A 4-wave longitudinal design was used to examine protective links from child competence to behavioral problems in first- (M=10.97 years) and second- (M=8.27 years) born rural African American children. At 1-year intervals, teachers assessed child behavioral problems, mothers reported their psychological functioning, and both mothers and children reported parenting practices. Structural equation modeling indicated that child competence was linked with residualized positive changes in mothers' psychological functioning from Wave 1 to Wave 2. Mothers' psychological functioning and child competence at Wave 2 forecast involved-supportive parenting at Wave 3, which was associated negatively with externalizing and internalizing problems at Wave 4. The importance of replicating processes leading to outcomes among children in the same study is discussed.

Maternal resources, parenting, and dietary patterns among rural African American children in single-parent families.

A correlation study was designed to test the hypothesis that maternal education, perceived family resources, and the importance of family routines would be related to children's dietary patterns. Additionally, the study examined the hypothesis that dietary patterns would be associated with children's cognitive and physical abilities. The sample for this study included 159 African American single-mother families with a 6- to 9-year-old child living in rural areas, most of whom lived in poverty. Children's eating patterns were assessed using a self-report questionnaire administered to the mother in an interview format. Children's cognitive ability was measured by several subscales from the Woodcock Johnson Psycho-Educational Instrument and the Harter Perceived Competence Scale for children. For male children, the mother's higher education was related to more adequate eating patterns at home, and more perceived family resources were related to the likelihood of taking vitamin supplements. For female children, greater milk intake was positively related to cognitive outcomes, including applied problem, passage comprehension, calculation, synonym identification, antonym identification, and quantitative concept scores. Milk intake was clearly related to more optimal cognitive development. The results of this study support the literature related to the importance of nutrition for cognitive and physical abilities in children.

Intra- and Extracultural Perceptions of Competence in Rural African American Youth

This study was designed to determine the extent to which adults' ratings of cognitive and social competence among rural African American children converge. Hypotheses about the conditions under which intracultural and extracultural raters perceive children's competencies similarly were also tested. Mothers, fathers, relatives, family friends, and teachers independently assessed cognitive and social competence for a sample of 91 rural African American children. The data supported predictions that ratings of cognitive competence would be more similar across raters than would ratings of social competence, and that parents' involvement in their children's schools would be associated with more similarity in parents' and teachers' ratings of child competence. Identification of the processes that help African American children to function well in both intracultural and extracultural settings is important.

The Rural Child

76 Presentation THE RURAL CHILD L.C. DORSEY, D.S.W. Executive Director Delta Health Center, Inc. Post Office Drawer 900 Mound Bayou, Mississippi 38762 Children born today in rural America begin life with numerous strikes against them. The quality of rural life is determined by distance, which affects access to health care. Rural children born in Mississippi are at greater risk of dying during the first year of life than are their urban counterparts in any other state. Rural African-American children in Mississippi are twice as likely to die during the first year of life than are their white counterparts. The rural child born today has less access to quality education, and in some states, such as Mississippi, will have difficulty receiving the higher education and skills needed to compete in the job market in the 21st century. The rural child is more often poor and bears the brunt of the spiritbending deprivation of rural poverty. Rural children today live in a world of dichotomous images. On the one hand, scenes from color television tease them about a life of bountiful materialism. On the other, the realities of the world around them, which often include inadequate housing, food, health care, and clothing, mock the televised images. The rural child is increasingly threatened with the problems of inner-city urban living: drugs, crime, gang violence. Rural children also face mounting environmental problems: agricultural chemicals in the air and water, and diminishing water tables caused by the proliferation of such water-based agricultural projects as catfish ponds, rice paddies, and increased irrigation of other crops. Rural children are at risk of never receiving adequate health care, competitive education, a livable income, or cultural enrichment. However, they are at greatest risk of neglect. Societal indifference to children and the importance of considering children as a priority were recently explored by well-docuJournal of Health Care for the Poor and Underserved, Vol. 2, No. 1, Summer 1991 ___________________________________Dorsey________________________________77_ mented presentations at the World Summit for Children, where leaders from over 30 countries gathered to discuss the plight of 150 million children under five years of age who suffer from malnutrition, 30 million whose homes are the streets, and seven million children who live in refugee camps due to war or famine in their homelands.1 Our neglect of American children is the result of neither war nor famine, yet children rank low on our national priority list. On any given day in the United States, a child drops out of school every eight seconds, and every 26 seconds, a child runs away from home. A child is abused every 47 seconds, and a teen gives birth every 67 seconds. Every seven minutes, a child is arrested for a drug-related crime; a child is killed or injured every 36 minutes by a gun; and a staggering 135,000 children bring guns to school every day.2 Rural and urban leaders in America seem unwilling to address the underlying causes of these statistical profiles. In 1988, over 12 million children in the United States—one in five—were living in poverty, a condition long recognized as a cause of crime.3 AfricanAmerican and Hispanic children are among America's poorest citizens and are at great risk of becoming school dropouts, unemployed adults, victims of crime, and prison inmates.4 In addition, African-American children are at high risk of premature death as victims of homicide, accidents, and chronic disease. The number of American children living in poverty increased 23 percent between 1979 and 1988.3 Despite these alarming trends and social indicators, Congress has consistently failed to enact policies which would protect our children.1 At a time when the United States commands the technology to send men to the moon or to rapidly deploy hundreds of thousands of soldiers to a desert halfway across the world, the plight of our children is represented by these basic facts: • One in five children lives in poverty.3 • More than 12 million children and more than 14 million women of childbearing age have no health insurance.3 • The United States ranks 19th in the world in preventing infant deaths, behind Hong Kong, Spain, and war...