Maureen M. Black

Inequality in early childhood: Risk and protective factors for early child development

Inequality between and within populations has origins in adverse early experiences. Developmental neuroscience shows how early biological and psychosocial experiences affect brain development. We previously identified inadequate cognitive stimulation, stunting, iodine deficiency, and iron-deficiency anaemia as key risks that prevent millions of young children from attaining their developmental potential. Recent research emphasises the importance of these risks, strengthens the evidence for other risk factors including intrauterine growth restriction, malaria, lead exposure, HIV infection, maternal depression, institutionalisation, and exposure to societal violence, and identifies protective factors such as breastfeeding and maternal education. Evidence on risks resulting from prenatal maternal nutrition, maternal stress, and families affected with HIV is emerging. Interventions are urgently needed to reduce childrens risk exposure and to promote development in affected children. Our goal is to provide information to help the setting of priorities for early child development programmes and policies to benefit the worlds poorest children and reduce persistent inequalities.

Longscan: A consortium for longitudinal studies of maltreatment and the life course of children

The National Research Council (1993) has issued an urgent call for theory-based, longitudinal research to examine the antecedents and consequences of child maltreatment. Many of the concerns raised by the National Research Council are addressed by LONGSCAN (LONGitudinal Studies of Child Abuse and Neglect), a consortium including a coordinating center and five independent prospective longitudinal investigations sharing common protocols for data collection, entry, and management. The children in the five investigations vary by their level of risk, ranging from a community sample with no identified risk beyond low income status, to children placed in foster care. The longitudinal study has been designed with six age-specific data collection points extending from 4 through 20 years of age. The conceptual model, organization, and analytic strategy for LONGSCAN are described.

Children in low-income, urban settings. Interventions to promote mental health and well-being

Urbanization provides unique political, cultural, economic, and educational opportunities for children and families. However, it may also have a negative impact on the mental health and well-being of children and adolescents, particularly when they are exposed to settings with high rates of crime, violence, delinquency, substance use, abuse, and poverty. Psychologists are well suited to intervene in problems associated with urbanization. However, most psychological services have been directed toward children who are experiencing problems, and there has been less focus on population-based or preemptive interventions that prevent problems before they occur. This review presents 11 recommendations for urban interventions that build on individual, family, and community strengths to promote the mental health and well-being of urban children and adolescents.

Infant feeding practices of low-income, African-American, adolescent mothers: an ecological, multigenerational perspective

The early introduction of non-milk foods among African-American infants has been well documented. Several studies report the addition of semi-solids as early as 1-2 weeks of age. This study investigated, through ethnographic, repeat indepth interviews with teen mothers and grandmothers of infants, the determinants of such feeding practices and the inter-generational factors involved in infant feeding decision-making. Nineteen adolescent mothers were recruited from Baltimore City WIC programs. The teen mothers were interviewed in their homes during four separate visits and the grandmothers at least twice. Ethnographic field guides focused on questions about what, why and how infants were fed and on the ethnotheories of parenting and infant care in this population. All interviews were taped and transcripts were analyzed using text retrieval software. Results confirmed that it is the cultural norm to feed cereal in the bottle and to feed other semi-solid foods within the first month of life. Most grandmothers played the dominant role in deciding what the infant should eat and the timing of the introduction of solids. This pattern occurred both because grandmothers had extensive physical access to their grandchildren and because teen mothers were dependent upon grandmothers. The use of qualitative research methods, with an ecological, multi-generational focus, provides a rich description of the context within which infant feeding decisions are made.

A Conceptual Definition of Child Neglect

Although child neglect is the most common form of child maltreatment, considerable confusion remains regarding its definition. A conceptual definition of neglect is presented based on an ecological model of child maltreatment. The definition focuses on the basic needs of children that are not met, rather than on the intentions or behavior of parents. The replacement of parental culpability by a shared responsibility including parents, families, the community, and society is suggested. Neglect is seen as a heterogeneous phenomenon that varies by type, severity, and chronicity. In addition, neglect is understood as existing on a continuum ranging from optimal to grossly inadequate care. The context within which neglect occurs, including parents understanding of childrens needs, religious and cultural beliefs, and poverty, influences the approaches of clinicians, researchers, and policymakers toward the problem of child neglect.

Young, Disadvantaged Fathers' Involvement With Their Infants: An Ecological Perspective

PURPOSEnTo investigate fathers involvement with their children using an ecological model, multiple respondents, and a comprehensive definition of fathers involvement. The studys primary objectives were: (a) to describe the characteristics of fathers whose infants are born to low-income, urban, African-American adolescent mothers; (b) to describe the ways in which fathers are involved with their children; and (c) to identify factors associated with fathers involvement.nnnMETHODSnA total of 181 first-time mothers (aged <18 years) living in three-generation households (infant, mother, and grandmother) were recruited from three urban hospitals shortly after delivery and invited to participate in a longitudinal study of parenting. Mothers provided the name of their infants father; 109 (60%) of the fathers also agreed to participate. Baseline interviews of mothers, fathers, and grandmothers addressed demographic characteristics, relationships, and the fathers involvement with his child.nnnRESULTSnThree multivariate regression models were used to identify factors associated with paternal involvement, explaining 35% to 51% of the variability in father involvement. Regardless of the respondent (mother, father, or grandmother), paternal involvement was predicted most strongly by the quality of the parents romantic relationship. The fathers employment status, the maternal grandmothers education, and the fathers relationship with the babys maternal grandmother were also associated with paternal involvement.nnnCONCLUSIONSnThe study confirmed the value of an ecological perspective that uses multiple informants and a comprehensive definition of father involvement that includes multiple role functions. Efforts to increase paternal involvement should help young parents separate the fathers relationship with their child from the romantic relationship between the mother and father, address the roles played by maternal grandmothers, and assist fathers to complete their education, and obtain and keep jobs.

Delaying second births among adolescent mothers: a randomized, controlled trial of a home-based mentoring program.

CONTEXT. Rates of rapid second births among low-income black adolescent mothers range from 20% to 50%. Most efforts to prevent rapid second births have been unsuccessful. OBJECTIVES. There were 4 objectives: (1) to examine whether a home-based mentoring intervention was effective in preventing second births within 2 years of the adolescent mothers first delivery; (2) to examine whether greater intervention participation increased the likelihood of preventing a second birth; (3) to examine whether second births were better predicted from a risk practice perspective or a family formation perspective, based on information collected at delivery; and (4) to examine how risk practices or family formation over the first 2 years of parenthood were related to a second birth. DESIGN. We conducted a randomized, controlled trial of a home-based intervention curriculum, based on social cognitive theory, and focused on interpersonal negotiation skills, adolescent development, and parenting. The curriculum was delivered biweekly until the infants first birthday by college-educated, black, single mothers who served as mentors, presenting themselves as “big sisters.” The control group received usual care. Follow-up evaluations were conducted in the homes 6, 13, and 24 months after recruitment. METHODS. Participants were recruited from urban hospitals at delivery and were 181 first time, black adolescent mothers (<18 years of age); 82% (149 of 181) completed the 24-month evaluation. RESULTS. Intent-to-treat analyses revealed that control mothers were more likely than intervention mothers to have a second infant. The complier average causal effect was used to account for variability in intervention participation. Having ≥2 intervention visits increased the odds of not having a second infant more than threefold. Only 1 mother who completed ≥6 visits had a second infant. At delivery of their first infant, mothers who had a second infant were slightly older (16.7 vs 16.2 years) and were more likely to have been arrested (30% vs 14%). There were no differences in baseline contraceptive use or other measures of risk or family formation. At 24 months, mothers who had a second infant reported high self-esteem, positive life events, and romantic involvement and residence with the first infants father. At 24 months, there were no differences in marital rates (2%), risk practices, or contraceptive use between mothers who did and did not have a second infant. Mothers who did not have a second infant were marginally more likely to report no plans for contraception in their next sexual contact compared with mothers who had a second infant (22% vs 8%, respectively). CONCLUSIONS. A home-based intervention founded on a mentorship model and targeted toward adolescent development, including negotiation skills, was effective in preventing rapid repeat births among low-income, black adolescent mothers. The effectiveness of the intervention could be seen after only 2 visits and increased over time. There were no second births among mothers who attended ≥8 sessions. There was no evidence that risk behavior or contraceptive use was related to rapid second births. There was some evidence that rapid second births among adolescent mothers were regarded as desirable and as part of a move toward increasing autonomy and family formation, thereby undermining intervention programs that focus on risk avoidance. Findings suggest the merits of a mentoring program for low-income, black adolescent mothers, based on a relatively brief (6–8 sessions) curriculum targeted toward adolescent development and interpersonal negotiation skills.

Measurement of three major subtypes of child neglect

This study examines the relationships among three major subtypes of neglect (physical, psychological, and environmental), a summary measure of neglect, and neglect as defined by Child Protective Services (CPS). The predictive validity of the subtypes of neglect assessed when children were 5 years of age was examined using children’s behavior at age 6. Study findings include modest to moderate correlations among the neglect subtypes, CPS neglect, and children’s behavior. After controlling for CPS neglect, the subtypes remained predictive of children’s behavior. The set of three subtypes was more strongly related to children’s behavior, particularly maternal report of internalizing problems, than was the summary neglect measure. These findings suggest that considering the subtypes of neglect may enhance our understanding of neglect and lead to interventions tailored to families’ specific needs.

Family processes within three-generation households and adolescent mothers' satisfaction with father involvement

This investigation used a family systems perspective to examine how family dynamics within 3-generation households were associated with mothers satisfaction with father involvement. The participants were low-income African American adolescent mothers (n=148) and grandmothers recruited at delivery and followed over 6 months. The overall model explained 68% of the variance in satisfaction with father involvement. Fathers who were involved with caregiving activities had positive relationships with adolescent mothers and grandmothers. Grandmothers served as gatekeepers; when grandmothers reported positive relationships with the 2 young parents, adolescent mothers reported positive relationships with their male partners. Mothers who reported positive partner relationships also reported high parenting efficacy and satisfaction with father involvement. Efforts to increase paternal involvement should focus on role clarification for grandmothers and fathers and on parenting activities for mothers and fathers, regardless of their romantic relationship.

Perceptions of Sexual Behavior among Urban Early Adolescents Translating Theory through Focus Groups

Risk activities for acquisition of the human immunodeficiency virus (HIV) remain prevalent among urban adolescents. Early adolescents represent a particularly vulnerable group, exhibiting high rates of unprotected sexual activity. In spite of a growing recognition of the need to examine cultural, environmental, and developmental variables contributing to both risk and protective behaviors, little such research has been described to date. Guided by the constructs of a model of risk-protective behavior (Protection Motivation Theory) and employing ethnographic techniques, an exploration of the developmental, sociohistorical, and cultural constructs that might influence adolescent sexual behavior was conducted. Focus group and individual interviews were conducted among 64 inner-city youths, 10 to 14 years of age, and their parents. Findings relevant to perceptions of sexual behavior among young adolescents are presented. The methodology employed in this exploratory phase and the strengths and limitations of focus group discussions are discussed