Significant Indirect Association Research Articles

Appalachian and Non-Appalachian Pediatricians’ Encouragement of the Human Papillomavirus Vaccine: Implications for Health Disparities

Background In medically underserved regions such as Appalachia, cervical cancer incidence and mortality are higher than the general U.S. population; therefore, it is important for pediatricians to encourage parents to have their daughters vaccinated against the human papillomavirus (HPV). Unfortunately, little is known about the predictors of pediatricians’ encouragement of the HPV vaccine among medically underserved populations. The current study compared attitudes and behaviors of pediatricians with practices in Appalachia with those in non-Appalachia to identify potential strategies for reducing health disparities. Methods A survey was conducted with 334 pediatricians located in Appalachia and non-Appalachia counties to examine how prior behavior, perceived susceptibility, severity, self-efficacy, response-efficacy, and behavioral intentions are related to self-reported vaccine encouragement. Results Pediatricians in Appalachia perceived their patients to be less susceptible to HPV and reported lower rates of HPV encouragement than pediatricians in non-Appalachia. In addition, self-efficacy had a significant indirect association with vaccine encouragement for pediatricians in non-Appalachia. Conclusion This study’s findings emphasize the importance of increasing Appalachian pediatricians’ awareness of their patients’ susceptibility to HPV. Broader efforts to increase encouragement of the HPV vaccine among pediatricians should focus on promoting self-efficacy to encourage the HPV vaccine to parents of young females.

Child behavior problems among cocaine-exposed toddlers: Indirect and interactive effects

This study examined the role of maternal psychopathology and maternal warmth as mediators of the association between prenatal cocaine and other substance exposure and toddler behavior problems. It was also hypothesized that infant cortisol reactivity and environmental risk may moderate these associations. Participants were 220 caregiver-infant dyads (119 cocaine exposed, 101 not cocaine exposed; 49% boys). Mother-infant dyads were recruited at delivery with assessments at 4-8 weeks and 7, 13, and 18 months of child ages. Results yielded no direct associations between prenatal cocaine/other substance exposure and toddler behavior problems, but significant indirect associations between prenatal cigarette/alcohol exposure and toddler behavior problems at 18 months. With regard to moderation, results indicated an indirect association between prenatal cocaine exposure and toddler behavior problems via lower maternal warmth for children with higher, but not lower, cortisol reactivity at 7 months. Results suggest potential pathways to toddler behavior problems among children at high biological risk.

Maternal cocaine use and mother–toddler aggression

This study examined the direct and indirect associations between maternal cocaine use during pregnancy and mother–toddler aggression in an interactive context at 2 years of child age. We hypothesized that in addition to direct effects of cocaine exposure on maternal and child aggression, the association between maternal cocaine use and mother–toddler aggression may be indirect via higher maternal psychiatric symptoms, negative affect, or poor infant autonomic regulation at 13 months. Participants consisted of 220 (119 cocaine exposed, 101 non-cocaine exposed) mother–toddler dyads participating in an ongoing longitudinal study of prenatal cocaine exposure. Results indicated that mothers who used cocaine during pregnancy displayed higher levels of aggression toward their toddlers compared to mothers in the control group. Results from model testing indicated significant indirect associations between maternal cocaine use and maternal aggression via higher maternal negative affect as well as lower infant autonomic regulation at 13 months. Although there were no direct associations between cocaine exposure and toddler aggression, there was a significant indirect effect via lower infant autonomic regulation at 13 months. Results highlight the importance of including maternal aggression in predictive models of prenatal cocaine exposure examining child aggression. Results also emphasize the important role of infant regulation as a mechanism partially explaining associations between cocaine exposure and mother–toddler aggression.

Lower maternal folate status in early pregnancy is associated with childhood hyperactivity and peer problems in offspring

Maternal nutrition during pregnancy has been linked with fetal brain development and psychopathology in the offspring. We examined for associations of maternal folate status and dietary intake during pregnancy with brain growth and childhood behavioural difficulties in the offspring. In a prospective cohort study, maternal red blood cell folate (RCF) was measured at 14 weeks of pregnancy and total folate intake (TFI) from food and supplements was assessed in early and late pregnancy. The offspring's head circumference and body weight were measured at birth and in infancy, and 100 mothers reported on children's behavioural difficulties at a mean age of 8.75 years using the Strengths and Difficulties Questionnaire. Lower maternal RCF and TFI in early pregnancy were associated with higher childhood hyperactivity (RCF: beta = -.24; p = .013; TFI: beta = -.24; p = .022) and peer problems scores (RCF: beta = -.28; p = .004; TFI: beta = -.28; p = .009) in the offspring. Maternal gestational RCF was positively associated with head circumference at birth (adjusted for gestational age), and mediation analyses showed significant inverse indirect associations of RCF with hyperactivity/inattention and peer problems via fetal brain growth. Adjustment for mother's smoking and drinking alcohol during pregnancy did not change the results. Although the associations are small and residual confounding is possible, our data provide preliminary support for the hypothesis that lower folate status in early pregnancy might impair fetal brain development and affect hyperactivity/inattention and peer problems in childhood.

A Conceptual Model Predicting Internalizing Problems in Middle Childhood Among Children of Alcoholic and Nonalcoholic Fathers: The Role of Marital Aggression

The purpose of this study was to test a conceptual model predicting children's anxiety/depression in middle childhood in a community sample of children with parents who had alcohol problems (n = 112) and those without alcohol problems (n = 101). The conceptual model examined the role of parents' alcohol diagnoses, depression, and antisocial behavior among parents of children ages 12 months to kindergarten age in predicting marital aggression and parental aggravation. Higher levels of marital aggression and parental aggravation were hypothesized to predict children's depression/anxiety within time (18 months to kindergarten age and, prospectively, to age during fourth grade). The sample was recruited from New York State birth records when the children were 12 months old. Assessments were conducted at 12, 18, 24, and 36 months; at kindergarten age; and during fourth grade. Children with alcoholic fathers had higher depression/anxiety scores according to parental reports but not self-reports. Structural equations modeling was largely supportive of the conceptual model. Fathers' alcoholism was associated with higher child anxiety via greater levels of marital aggression among families with alcohol problems. Results also indicated that there was a significant indirect association between parents' depression symptoms and child anxiety via marital aggression. The results highlight the nested nature of risk characteristics in alcoholic families and the important role of marital aggression in predicting children's anxiety/depression. Interventions targeting both parents' alcohol problems and associated marital aggression are likely to provide the dual benefits of improving family interactions and lowering risk of children's internalizing behavior problems.

Food Insecurity Works through Depression, Parenting, and Infant Feeding to Influence Overweight and Health in Toddlers ,

We used the Early Childhood Longitudinal Study-Birth Cohort 9- and 24-mo surveys (n = 8693) and Structural Equation Modeling to examine direct and indirect associations between food insecurity and toddlers’ overweight (weight for length), physical health, and length for age. There were significant effects of food insecurity on parental depression and parental depression in turn influenced physical health. There were also significant effects of food insecurity on parenting practices, which in turn were significantly associated with infant feeding and subsequently toddlers’ overweight. There were no significant direct or indirect associations between food insecurity and toddlers’ length for age. Our results show that food insecurity influences parenting, including both depression and parenting practices. Findings suggest parental depression is a stressor on parenting behavior that social policy should address to alleviate problematic child health outcomes. Findings underscore the importance of continuing and strengthening policy initiatives to ensure that families with infants and toddlers have sufficient, predictable, and reliable food supply.

Personal and Family Factors as Predictors of Pupils' Mathematics Achievement

This study examined personal and family factors in prediction of mathematics achievement by Kuwaiti fourth graders (395 boys, 501 girls; M age=10.0 yr., SD=8.0 mo.). Personal variables included sex, total achievement, perception of parental involvement, pupil's attitude towards school, and mathematics achievement. Family variables included parental education and parental involvement, views of school, and income. The data had good fit with the suggested model. Analysis showed variables which had significant direct association with mathematics achievement were total achievement and sex. Parental education, pupil's sex, and attitude towards school had significant indirect associations with mathematical achievement. Associations were direct for boys and indirect for girls on mathematics achievement, so sex had minimal total effects on mathematics achievement.

Direct and Indirect Associations of Neighborhood Disorder With Drug Use and High-Risk Sexual Partners

On a macrosocial level, neighborhood characteristics have been found to be associated with the prevalence of HIV and other bloodborne and sexually transmitted infections. The current study used structural equation modeling to examine the relationship between neighborhood social and physical disorder and high-risk sexual partners. A cohort (N=838) recruited for an HIV prevention study of drug users (2002-2004) in Baltimore, Maryland, was interviewed about their neighborhood characteristics, drug use, depressive symptoms (using the Centers for Epidemiological Studies Depression Scale), and HIV/sexually transmitted infection risk behaviors of exchanging sex for money or drugs, having multiple sexual partners, and having partners who injected drugs or smoked crack cocaine. Data were analyzed in February 2005. Model fit statistics from Mplus (Muthen & Muthen, Los Angeles CA, 2004) indicated statistically significant direct associations between neighborhood disorder and psychologic distress, neighborhood disorder and sexual risk behaviors, and neighborhood disorder and drug use. There were also significant indirect associations of neighborhood disorder on sexual risk behaviors. These results highlight the importance of viewing drug use, chronic stress, depression and hopelessness, and infectious diseases such as HIV and hepatitis C as interlinked epidemics that are fostered by neighborhood social and physical disorder. Neighborhood, network, and community level interventions are needed to address these intertwined public health issues.

Community Influences on Adjustment in First Grade: An Examination of an Integrated Process Model

We examined the impact of neighborhood characteristics both directly and indirectly as mediated by parent coaching and the parent/child affective relationship on behavioral and school adjustment in a sample of urban dwelling first graders. We used structural equations modeling to assess model fit and estimate direct, indirect, and total effects of neighborhood structural and social characteristics on parenting behavior and child outcomes. Observed physical incivilities in the neighborhood were associated with lower levels of parent eliciting behavior and higher levels of child behavior problems. The effects of neighborhood structural characteristics were mediated partially through neighborhood community involvement with children, which had a direct significant impact on parent eliciting behavior and an indirect effect on child behavior problems. Neighborhood community involvement with children was associated with higher levels of parent eliciting behavior and lower levels of child behavior problems. Observed physical incivilities had a significant indirect association with poor school adjustment and a marginally significant association with positive school adjustment to first grade. Neighborhood community involvement with children was more strongly associated with positive school adjustment than poor school adjustment.

A structural equation model relating impaired sensorimotor function, fear of falling and gait patterns in older people

Many falls in older people occur while walking, however the mechanisms responsible for gait instability are poorly understood. Therefore, the aim of this study was to develop a plausible model describing the relationships between impaired sensorimotor function, fear of falling and gait patterns in older people. Temporo-spatial gait parameters and acceleration patterns of the head and pelvis were obtained from 100 community-dwelling older people aged between 75 and 93 years while walking on an irregular walkway. A theoretical model was developed to explain the relationships between these variables, assuming that head stability is a primary output of the postural control system when walking. This model was then tested using structural equation modeling, a statistical technique which enables the testing of a set of regression equations simultaneously. The structural equation model indicated that: (i) reduced step length has a significant direct and indirect association with reduced head stability; (ii) impaired sensorimotor function is significantly associated with reduced head stability, but this effect is largely indirect, mediated by reduced step length, and; (iii) fear of falling is significantly associated with reduced step length, but has little direct influence on head stability. These findings provide useful insights into the possible mechanisms underlying gait characteristics and risk of falling in older people. Particularly important is the indication that fear-related step length shortening may be maladaptive.

A Multi-National Study of Interparental Conflict, Parenting, and Adolescent Functioning

This study assessed the associations between interparental conflict (IPC), parenting, and individual functioning among data gathered from school-going adolescents in Bangladesh, China, India, Bosnia, Germany, Palestine, Colombia, United States and three ethnic groups within South Africa. Specifically, we tested the validity of the spillover dynamic found in much research in the U.S., whereby marital conflict spills over into parenting and into the psychological and social functioning of children and adolescents. Previous analyses of these same data showed complete invariance in the linkages between parenting and adolescent functioning. This study thus provided a meaningful extension to the substantive literature on family processes. We followed recommendations within cross-cultural psychology to “transport and test” models validated in one culture to other cultures as an initial step in systematic comparative research. The findings revealed substantial invariance across the samples in documenting significant direct and indirect associations. Similar to prior research in the U.S., IPC was associated with youth outcomes directly, and more often indirectly, via parenting.

EFFECT OF MEDIATING VARIABLES ON THE ASSOCIATION BETWEEN PHYSICAL ACTIVITY OF PARENT AND CHILD

PURPOSE: The purpose of this study was to assess the effect of mediating variables on the association between physical activity of parent and child. METHODS: In September COctober 1996, computer-assisted telephone interviews were conducted among 1,504 parent-child pairs residing in the U.S. Trained interviewers asked each parent and a randomly selected child from the same household a series of questions about physical activity, for the parent and the child, and five mediating variables: parental encouragement, role modeling, financial support, and attitudes toward physical activity of the parent and of the child. At least four attempts were made to reach the telephone number before it was retired from the sample. Of households contacted, fourteen percent had eligible parent-child pairs, among whom 72% completed the survey. The mean interview length for both parent and child was 34 minutes. Structural equation modeling was used to test the hypotheses that parental physical activity was: (1) directly associated with physical activity of the child, or (2) was indirectly associated via mediating psychosocial variables. RESULTS: The direct association between parental and child physical activity was not statistically significant (p > 0.05). However, a test of the aggregate model that included all five mediating variables revealed a significant indirect association (r = 0.20) with parental physical activity and physical activity of the child. For individual mediating variables that were significant, we declared as important those associations whose absolute value was > = 0.30. Important positive associations were observed between parental physical activity and parental mediating variables (values in parentheses): financial support (0.43), attitude (0.32), and role modeling (0.43). Parental role modeling was also associated with the child's attitude toward physical activity (0.30). CONCLUSION: These cross-sectional data reveal that parental role modeling of physical activity behaviors may positively influence children's attitudes toward physical activity and suggest an important focus for media as part of health promotion efforts.

Alcohol use during pregnancy & neonatal outcome

A conceptual model of the association between prenatal cocaine exposure (PCE) and child self-regulation via maternal harshness and language development was examined. Specifically, the model tested whether PCE was associated with self-regulation either directly or indirectly via high maternal harshness and poor language development. The role of child sex, autonomic reactivity, and cumulative environmental risk as potential moderators was also explored. The sample was 216 mother–child dyads recruited at birth and assessed at 2, 7, 13, 24, 36, and 48 months of child ages. Participating mothers were primarily African American (72%). Results indicated a significant indirect association between PCE and child effortful control at 36 months via higher maternal harshness. Autonomic reactivity moderated the association between maternal harshness and self-regulation such that among children with poor autonomic reactivity, high maternal harshness was associated with lower conscience at 3 years. Child sex and environmental risk did not moderate the association between PCE and self-regulation. Thus, the quality of caregiving experience played a significant role in the development of self-regulation among PCE children, especially those at higher autonomic risk. In particular, PCE children who also exhibit poor autonomic reactivity may be particularly susceptible to environmental influences such as parenting.