Margaret O Brien Caughy

Neighborhood risk factors for low birthweight in Baltimore: a multilevel analysis.

OBJECTIVES Past research on low birthweight has focused on individual-level risk factors. We sought to assess the contribution of macrolevel social factors by using census tract-level data on social stratification, community empowerment, and environmental stressors. METHODS Census tract-level information on social risk was linked to birth certificate records from Baltimore, Md, for the period 1985 through 1989. Individual level factors included maternal education, maternal age, medical assistance health insurance (Medicaid), and trimester of prenatal care initiation. Methods of multilevel modeling using two-stage regression analyses were employed. RESULTS Macrolevel factors had both direct associations and interactions with low birthweight. All individual risk factors showed interaction with macrolevel variables; that is, individual-level risk factors for low birthweight behaved differently depending upon the characteristics of the neighborhood of residence. For example, women living in high-risk neighborhoods benefited less from prenatal care than did women living in lower-risk neighborhoods. CONCLUSIONS Multilevel modeling is an important tool that allows simultaneous study of macro- and individual-level risk factors. Multilevel analyses should play a larger role in the formulation of public health policies.

The influence of racial socialization practices on the cognitive and behavioral competence of African American preschoolers

The association between parent racial socialization and child competence was examined in a socioeconomically diverse sample of African American preschoolers living in an urban setting. Interviews were conducted in the homes of 200 families. Racial socialization was assessed by parent report as well as by observation of the sociocultural context of the home, and child outcomes were assessed using the Kaufman Assessment Battery for Children and the Child Behavior Checklist. Results indicated that African American parents who provided homes that were rich in African American culture had preschool children who had greater amounts of factual knowledge and better developed problem-solving skills. African American parents who socialized their preschool children to be proud of their heritage reported fewer problem behaviors.

A brief observational measure for urban neighborhoods

There is growing recognition that neighborhood context contributes to the health and well-being of residents over and above individual characteristics and health behaviors. However, few published reports exist of methods for documenting neighborhood characteristics which are easily administered with minimal outlay of resources. In this paper, we present the development of a brief observational method for urban neighborhoods relevant to the health and well-being of families and children. Data from a socieconomically diverse group of urban neighborhoods are used to create theoretically grounded measures of neighborhood context, and the utility of these measures for discriminating between and within urban neighborhoods is demonstrated.

Behavioral and Physiologic Effects of Nonnutritive Sucking during Gavage Feeding in Preterm Infants

ABSTRACT: Behavioral and physiologic responsivity to nasogastric gavage feeding was assessed in 36 preterm infants on 2 consecutive d. On one of these days, a pacifier was provided during and after the gavage segment of the standardized protocol. The protocol was divided into segments that included baseline, preparatory handling, pregavagc, gavage, and postgavage periods. Patterns of cardiac (heart period and vagal tone), oxygen saturation, behavioral state, and defensive behavioral responses to gavage were quantified. These stable preterm infants responded to handling and gavage feeding with reductions in heart period, vagal tone, and oxygen saturation. These responses were not altered by provision of a pacifier, although there was a tendency for fewer episodes of bradycardia and oxygen desaturation. Conversely, behavioral state was affected significantly by nonnutritive sucking: when provided with a pacifier, infants exhibited less behavioral distress, spent less time in fussy and active awake states during and after feeding, and returned to a sleep state significantly faster. There is converging evidence to suggest that nonnutritive sucking lessens behavioral distress to iatrogenic stressors but does not alter physiologic responsiveness.

Direct observation of neighborhood attributes in an urban area of the US south: characterizing the social context of pregnancy

BackgroundNeighborhood characteristics have been associated with poor maternal and child health outcomes, yet conceptualization of potential mechanisms is still needed. Census data have long served as proxies for area level socioeconomic influences. Unique information captured by neighborhood inventories, mostly conducted in northern US and Canadian urban areas, has shown important aspects of the community environment that are not captured by the socioeconomic and demographic aggregated individual statistics of census data. In this paper, we describe a neighborhood data collection effort tailored to a southern urban area.MethodsThis study used data from the Pregnancy, Nutrition and Infection (PIN) prospective cohort study to describe neighborhoods where low- and moderate-income pregnant women reside. Women who participated in the PIN study and who resided in Raleigh, NC and its surrounding suburbs were included (n = 703). Neighborhood attributes captured by the inventory included litter, housing condition, road condition, and social interactions that informed theoretical constructs of physical incivility, territoriality and social spaces. US Housing and Population Census 2000 data at the block group level were also assessed to identify the unique contribution of directly observed data. We hypothesize that neighborhood environments can influence health through psychosocial mediated pathways that lead to increased stress, or through disadvantage leading to poor neighborhood resources, or by protective attributes through increased social control.ResultsFindings suggest that directly observed neighborhood attributes distinguished between different types of areas in which low-income pregnant non-Hispanic white and non-Hispanic black women lived. Theoretically informed scales of physical incivilities, territoriality and social spaces were constructed and found to be internally consistent. Scales were weakly associated indicating that these constructs capture distinct information about these neighborhoods. Physical incivilities, territoriality and social spaces scales were poorly explained by traditional census variables used to proxy neighborhood environment.ConclusionIf neighborhoods influence health through psychosocial mediated pathways then careful detailing of neighborhood attributes that contribute to stress or deterioration, beyond traditional socioeconomic status, are needed. We believe that measuring physical incivility, territoriality and social spaces as expressions of underlying issues of maintenance and social communication make important contributes to this field.

The Effect of Residential Neighborhood on Child Behavior Problems in First Grade

Child behavior problems have been identified as being responsible for the greatest reduction in quality of life for children between ages 1 and 19. In this study, we examine whether neighborhood social processes are associated with differences in child behavior problems in an economically and racially diverse sample of 405 urban-dwelling first grade children and whether parenting behavior mediates and/or moderates the effects of neighborhoods. Furthermore, we examine whether neighborhood social processes play the same role with regards to child behavior problems at differing levels of neighborhood economic impoverishment. Results of multivariate multilevel regression analyses indicate that a high negative social climate is associated with greater internalizing problems. High potential for community involvement for children in the neighborhood was associated with fewer behavior problems, but only in economically impoverished neighborhoods. Differences in parenting behavior did not appear to mediate neighborhood effects on behavior problems, and parenting characterized by a high degree of positive involvement was associated with fewer behavior problems in all types of neighborhoods.

The Africentric Home Environment Inventory: An Observational Measure of the Racial Socialization Features of the Home Environment for African American Preschool Children

The sociocultural context of the home is one of the most important socializing environments for young children. In this study, the authors describe an observational measure for racial socialization features of the home environment. Data were collected during home visits to 200 socioeconomically diverse urban African American families with preschool children, and a principal axis factor analysis revealed a single factor with an internal reliability of .88. The scale varied significantly by socioeconomic status and was significantly correlated with parent involvement and enrichment behaviors and child achievement and problem-solving ability. This inventory is an important complement to parent-report measures for the study of racial socialization and the development of preschool African American children and will contribute to the understanding of the importance of culturally anchored socialization practices for the optimal development of children of color.

Family income trajectory during childhood is associated with adiposity in adolescence: a latent class growth analysis

BackgroundChildhood socioeconomic disadvantage has been linked with obesity in cross-sectional research, although less is known about how changes in socioeconomic status influence the development of obesity. Researchers have hypothesized that upward socioeconomic mobility may attenuate the health effects of earlier socioeconomic disadvantage; while downward socioeconomic mobility might have a negative influence on health despite relative socioeconomic advantages at earlier stages. The purpose of the current study was to characterize trajectories of family income during childhood, and to evaluate the influence of these trajectories on adiposity at age 15.MethodsData were collected as part of the Study of Early Child Care and Youth Development (SECCYD) between 1991 and 2007 at 10 sites across the United States. A latent class growth analysis (LCGA) was conducted to identify trajectories of family income from birth to 15 years of age. Analyses of covariance (ANCOVAs) were conducted to determine whether measures of adiposity differed by trajectory, while controlling for relevant covariates.ResultsThe LCGA supported a 5-class trajectory model, which included two stable, one downward, and two upward trajectories. ANCOVAs indicated that BMI percentile, waist circumference, and skinfold thicknesses at age 15 differed significantly by trajectory, such that those who experienced downward mobility or stable low income had greater adiposity relative to the more advantaged trajectories. Conversely, upwardly mobile children and those with consistently adequate incomes had similar and more positive outcomes relative to the most disadvantaged trajectories.ConclusionsFindings suggest that promoting upward socioeconomic mobility among disadvantaged families may have a positive impact on obesity-related outcomes in adolescence.

Effects of cumulative risk on behavioral and psychological well-being in first grade: Moderation by neighborhood context

This study builds upon existing research by examining whether risk indices for child psychological well-being behave in the same way in different types of neighborhoods. Specifically, we sought to determine if neighborhood characteristics acted to exacerbate or, alternatively, to buffer risk factors at the family and/or child level. Families with a child entering first grade in Fall 2002 were recruited from Baltimore City neighborhoods, defined as census block groups. This study included 405 children, and data came from an interview with the primary caregiver and an assessment of the first grader. The dependent variables were externalizing behavior and internalizing problems. A family risk index consisting of 13 measures, and a child risk index consisting of three measures were the main independent variables of interest. We examined the effects of these indices on child psychological well-being and behavior across two neighborhood characteristics: neighborhood potential for community involvement with children and neighborhood negative social climate. Results of multivariate analyses indicated that cumulative family risk was associated with an increase in both internalizing and externalizing behavior problems. Perceived negative social climate moderated the effect of family risks on behavior problems such that more risk was associated with a larger increment in both externalizing behavior problems and psychological problems for children living in high versus low risk neighborhoods. These findings further emphasize the importance of considering neighborhood context in the study of child psychological well-being.

Partner abuse or violence, parenting and neighborhood influences on children's behavioral problems

We examined the relationship between neighborhood characteristics, parenting behaviors, experiences of intimate partner abuse or violence (IPV) and childrens behavioral problems in a socioeconomically diverse sample of 383 families residing in an urban environment. Data were collected in the Fall/Winter of 2002. The census block group of residence was used as our measure of neighborhood. Census block groups typically contain 1500 residents on average. IPV was measured using a modified version of the HITS (physically Hurt, Insult, Threaten, and Screamed at) scale, a short four item tool assessing emotional and physical violence to which we added an item capturing domination or emotional control. IPV in the last year was reported by 50% of the sample with rates varying by socioeconomic position; families with the lowest and highest income reported the most IPV. Patterns of association between parenting, neighborhood and the childrens behavioral problems differed for families who reported IPV in the last year compared to families who reported no IPV. While positive neighborhood characteristics such as high levels of Community Involvement with Children - based upon four scales capturing neighborhood levels of social interaction and collective socialization of children - were protective for high levels of behavioral problems among families not reporting IPV, this protective effect was not seen among families who did report IPV. Hypothesized interactions between negative neighborhood characteristics and IPV-namely that behavioral problems would be worse among families experiencing IPV in highly economically deprived or areas with negative social climates-were not supported by our data. These interactions between neighborhood factors and IPV were not explained by parental factors.