Dimitra Kamboukos

Early Childhood Family Intervention and Long-term Obesity Prevention Among High-risk Minority Youth

OBJECTIVES: To test the hypothesis that family intervention to promote effective parenting in early childhood affects obesity in preadolescence. METHODS: Participants were 186 minority youth at risk for behavior problems who enrolled in long-term follow-up studies after random assignment to family intervention or control condition at age 4. Follow-up Study 1 included 40 girls at familial risk for behavior problems; Follow-up Study 2 included 146 boys and girls at risk for behavior problems based on teacher ratings. Family intervention aimed to promote effective parenting and prevent behavior problems during early childhood; it did not focus on physical health. BMI and health behaviors were measured an average of 5 years after intervention in Study 1 and 3 years after intervention in Study 2. RESULTS: Youth randomized to intervention had significantly lower BMI at follow-up relative to controls (Study 1 P = .05; Study 2 P = .006). Clinical impact is evidenced by lower rates of obesity (BMI ≥95th percentile) among intervention girls and boys relative to controls (Study 2: 24% vs 54%, P = .002). There were significant intervention-control group differences on physical and sedentary activity, blood pressure, and diet. CONCLUSIONS: Two long-term follow-up studies of randomized trials show that relative to controls, youth at risk for behavior problems who received family intervention at age 4 had lower BMI and improved health behaviors as they approached adolescence. Efforts to promote effective parenting and prevent behavior problems early in life may contribute to the reduction of obesity and health disparities.

Promoting Effective Parenting Practices and Preventing Child Behavior Problems in School Among Ethnically Diverse Families From Underserved, Urban Communities

This study examines the efficacy of ParentCorps among 4-year-old children (N = 171) enrolled in prekindergarten in schools in a large urban school district. ParentCorps includes a series of 13 group sessions for parents and children held at the school during early evening hours and facilitated by teachers and mental health professionals. ParentCorps resulted in significant benefits on effective parenting practices and teacher ratings of child behavior problems in school. Intervention effects were of similar magnitude for families at different levels of risk and for Black and Latino families. The number of sessions attended was related to improvements in parenting. Study findings support investment in and further study of school-based family interventions for children from underserved, urban communities.

Understanding relations among early family environment, cortisol response, and child aggression via a prevention experiment.

This study examined relations among family environment, cortisol response, and behavior in the context of a randomized controlled trial with 92 children (M = 48 months) at risk for antisocial behavior. Previously, researchers reported an intervention effect on cortisol response in anticipation of a social challenge. The current study examined whether changes in cortisol response were related to later child aggression. Among lower warmth families, the intervention effect on aggression was largely mediated by the intervention effect on cortisol response. Although the intervention also resulted in significant benefits on child engaging behavior, cortisol response did not mediate this effect. These findings demonstrate meaningful associations between cortisol response and aggression among children at familial risk for antisocial behavior.

Cluster (School) RCT of ParentCorps: Impact on Kindergarten Academic Achievement

OBJECTIVE: To evaluate the impact of an early childhood, family-centered, school-based intervention on children’s kindergarten academic achievement. METHODS: This was a cluster (school) randomized controlled trial with assessments from pre-kindergarten (pre-k) entry through the end of kindergarten. The setting was 10 public elementary schools with 26 pre-k classes in 2 school districts in urban disadvantaged neighborhoods serving a largely black, low-income population. Participants were 1050 black and Latino, low-income children (age 4; 88% of pre-k population) enrolled in 10 schools over 4 years. Universal intervention aimed to promote self-regulation and early learning by strengthening positive behavior support and effective behavior management at home and school, and increasing parent involvement in education. Intervention included after-school group sessions for families of pre-k students (13 2-hour sessions; co-led by pre-k teachers) and professional development for pre-k and kindergarten teachers. The outcome measures were standardized test scores of kindergarten reading, writing, and math achievement by independent evaluators masked to intervention condition (primary outcome); developmental trajectories of teacher-rated academic performance from pre-k through kindergarten (secondary outcome). RESULTS: Relative to children in control schools, children in intervention schools had higher kindergarten achievement test scores (Cohen’s d = 0.18, mean difference = 2.64, SE = 0.90, P = .03) and higher teacher-rated academic performance (Cohen’s d = 0.25, mean difference = 5.65, SE = 2.34, P = .01). CONCLUSIONS: Early childhood population-level intervention that enhances both home and school environments shows promise to advance academic achievement among minority children from disadvantaged, urban neighborhoods.

An Examination of Sociodemographic Correlates of Ecstasy Use Among High School Seniors in the United States

Background: Although ecstasy (MDMA) use is not as prevalent in the United States (US) as it was in the early 2000s, use remains popular among adolescents and young adults. Few recent studies have examined ecstasy use in national samples among those at particularly high risk for use—adolescents approaching adulthood. Research is needed to delineate sociodemographic correlates of use in this group. Methods: Data were examined from a nationally representative sample of high school seniors in the US (modal age = 18) from the Monitoring the Future study (years 2007–2012; weighted N = 26,504). Data from all cohorts were aggregated and correlates of recent (last 12-month) use of ecstasy were examined. Results: Roughly 4.4% of high school seniors reported use of ecstasy within the last year. Females and religious students were consistently at lower odds for use. Black and Hispanic students, and students residing with two parents, were at lower odds for ecstasy use, until controlling for other drug use. Odds of use were consistently increased for those residing in a city, students with weekly income of >

Early Childhood Obesity Prevention in Low-Income, Urban Communities

50 from a job, and students earning >

Adverse psychosocial outcomes associated with drug use among US high school seniors: a comparison of alcohol and marijuana

10 weekly from other sources. Lifetime use of alcohol, cigarettes, marijuana, and other illicit drugs each robustly increased odds of ecstasy use. Conclusion: Subgroups of high school seniors, defined by specific sociodemographic factors, and those who have used other drugs, are currently at high risk for ecstasy initiation and use. Since ecstasy is regaining popularity in the US, prevention efforts should consider these factors.

Effects of ParentCorps in Prekindergarten on Child Mental Health and Academic Performance: Follow-up of a Randomized Clinical Trial Through 8 Years of Age

Given the disproportionately high rates of obesity-related morbidity among low-income, ethnic minority youth, obesity prevention in this population is critical. Prior efforts to curb childhood obesity have had limited public health impact. The present study evaluates an innovative approach to obesity prevention by promoting foundational parenting and child behavioral regulation. This pre–post intervention study evaluated an enhanced version of ParentCorps with 91 families of pre-Kindergarten students in low-income, urban communities. Assessments included tests of knowledge and parent report. Consistent with findings from two randomized controlled trials of ParentCorps, parent knowledge and use of foundational parenting practices increased and child behavior problems decreased. Child nutrition knowledge and physical activity increased and television watching decreased; for boys, sleep problems decreased. Comparable benefits occurred for children at high risk for obesity based on child dysregulation, child overweight, and parent overweight. Results support a “whole child,” family-centered approach to health promotion in early childhood.

Moderators of Intervention Effects on Parenting Practices in a Randomized Controlled Trial in Early Childhood

Abstract Objectives: There is debate about whether marijuana (cannabis) use is more dangerous than alcohol use. Although difficult to make objective comparisons, research is needed to compare relative dangers in order to help inform preventive efforts and policy. Methods: Data were analyzed from a nationally representative sample of high school seniors in the Monitoring the Future study (2007–2011; Weighted n = 7437; modal age: 18) who reported lifetime use of alcohol or marijuana. Students were asked to indicate whether they experienced various adverse psychosocial outcomes resulting from use of each substance. We examined which outcomes were more prevalent for each substance. Results: Compared to alcohol use, marijuana use was more commonly reported to compromise relationships with teachers or supervisors, result in less energy or interest, and result in lower school or job performance. Compared to marijuana use, alcohol was more commonly reported to compromise relationships with friends and significant others; it was also reported to lead to more regret (particularly among females), and driving unsafely. Marijuana users were more likely to report no adverse outcomes. Females and white students were more likely to report various adverse outcomes and higher frequency use of each substance also increased occurrences of reported adverse outcomes. Conclusions: Marijuana and alcohol are associated with unique adverse psychosocial outcomes. Outcomes differ by sex and race/ethnicity, and perception or experience of outcomes may also be related to legal status and associated stigma. Public health interventions may be more effective by focusing on harm reduction strategies for these drug-specific outcomes.

Family and Teacher Characteristics as Predictors of Parent Involvement in Education During Early Childhood Among Afro-Caribbean and Latino Immigrant Families

Importance Low-income minority children living in urban neighborhoods are at high risk for mental health problems and underachievement. ParentCorps, a family-centered, school-based intervention in prekindergarten, improves parenting and school readiness (ie, self-regulation and preacademic skills) in 2 randomized clinical trials. The longer-term effect on child mental health and academic performance is not known. Objective To examine whether ParentCorps delivered as an enhancement to prekindergarten programs in high-poverty urban schools leads to fewer mental health problems and increased academic performance in the early elementary school years. Design, Setting, and Participants This is a 3-year follow-up study of a cluster randomized clinical trial of ParentCorps in public schools with prekindergarten programs in New York City. Ten elementary schools serving a primarily low-income, black student population were randomized in 2005, and 4 consecutive cohorts of prekindergarten students were enrolled from September 12, 2005, through December 31, 2008. We report follow-up for the 3 cohorts enrolled after the initial year of implementation. Data analysis was performed from September 1, 2014, to December 31, 2015. Interventions ParentCorps included professional development for prekindergarten and kindergarten teachers and a program for parents and prekindergarten students (13 two-hour group sessions delivered after school by teachers and mental health professionals). Main Outcomes and Measures Annual teacher ratings of mental health problems and academic performance and standardized tests of academic achievement in kindergarten and second grade by testers masked to the intervention or control group randomization. Results A total of 1050 children (4 years old; 518 boys [49.3%] and 532 girls [50.7%]) in 99 prekindergarten classrooms participated in the trial (88.1% of the prekindergarten population), with 792 students enrolled from 2006 to 2008. Most families in the follow-up study (421 [69.6%]) were low income; 680 (85.9%) identified as non-Latino black, 78 (9.8%) as Latino, and 34 (4.3%) as other. Relative to their peers in prekindergarten programs, children in ParentCorps-enhanced prekindergarten programs had lower levels of mental health problems (Cohen d = 0.44; 95% CI, 0.08-0.81) and higher teacher-rated academic performance (Cohen d = 0.21; 95% CI, 0.02-0.39) in second grade. Conclusions and Relevance Intervention in prekindergarten led to better mental health and academic performance 3 years later. Family-centered early intervention has the potential to prevent problems and reduce disparities for low-income minority children. Trial Registration clinicaltrials.gov Identifier: NCT01670227.