Faculty Bibliography

BACKGROUND:Parents of children with special health care needs (CSHCN) are at risk of poorer health outcomes. Material hardships also pose significant health risks to parents. Little is known about how protective factors may mitigate these risks, and if effects are similar between mothers and fathers. METHODS:This was a cross-sectional survey study conducted using the US 2018/2019 National Survey of Children's Health, including parents of children 0-17 with income <200% of the Federal Poverty Level. Separately, for parents of children with and without special health care needs (N-CSHCN), weighted logistic regression measured associations between material hardship, protective factors (family resilience, neighborhood cohesion and receipt of family-centered care) and two outcomes: mental and physical health of mothers and fathers. Interactions were assessed between special health care needs status, material hardship and protective factors. RESULTS:Sample consisted of parents of 16,777 children, 4,440 were parents of CSHCN. Most outcomes showed similar associations for both mothers and fathers of CSHCN and N-CSHCN: material hardship was associated with poorer health outcomes, and family resilience and neighborhood cohesion associated with better parental health outcomes. Family-centered care was associated with better health of mothers but not fathers. Interaction testing showed that the protective effects of family resilience were lower among fathers of CSHCN experiencing material hardship. CONCLUSIONS:Family resilience and neighborhood cohesion are associated with better health outcomes for all parents, though these effects may vary by experience of special health care needs, parent gender and material hardship. WHAT'S NEW/UNASSIGNED:Protective factors such as family relationships, neighborhood cohesion and family-centered care are associated with better health outcomes for most parents. Particularly for fathers, experience of material hardship may reduce these protective effects.

OBJECTIVE:To examine whether prenatal or concurrent household food insecurity influences associations between maternal and toddler fruit and vegetable (FV) intake. DESIGN/METHODS:Application of a life-course framework to an analysis of a longitudinal dataset. SETTING/METHODS:Early childhood obesity prevention program at a New York City public hospital. PARTICIPANTS/METHODS:One-hundred and fifty-six maternal-toddler dyads self-identifying as Hispanic or Latino. VARIABLES MEASURED/METHODS:Maternal and toddler FV intake was measured using Centers for Disease Control and Prevention dietary measures when toddlers were aged 19 months. Household food insecurity (measured prenatally and concurrently at 19 months) was measured using the US Department of Agriculture Food Security Module. ANALYSIS/METHODS:Regression analyses assessed associations between adequate maternal FV intake and toddler FV intake. Interaction terms tested whether prenatal or concurrent household food insecurity moderated this association. RESULTS:Adequate maternal FV intake was associated with increased toddler FV intake (B = 6.2 times/wk, 95% confidence interval, 2.0-10.5, P = 0.004). Prenatal household food insecurity was associated with decreased toddler FV intake (B = -6.3 times/wk, 95% confidence interval, -11.67 to -0.9, P = 0.02). There was a significant interaction between the level of maternal-toddler FV association (concordance or similarity in FV intake between mothers and toddlers) and the presence of food insecurity such that maternal-toddler FV association was greater when prenatal household food insecurity was not present (B = -11.6, P = 0.04). CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:Strategies to increase FV intake across the life course could examine how the timing of household food insecurity may affect intergenerational maternal-child transmission of dietary practices.

PURPOSE/OBJECTIVE:We examined prospective associations between early childcare precarity, or the security and reliability of childcare arrangements, and subsequent maternal health. STUDY DESIGN/METHODS:We conducted a secondary analysis of survey responses from mothers of 2,836 children in the Future of Families and Child Wellbeing study. We assessed the following childcare measures: insecure childcare, insecure childcare with missed work, inadequate childcare, and emergency childcare support. We used linear and logistic regression models with robust standard errors to examine associations between these measures when the index child was age 3 and maternal health outcomes (overall health, depression, and parenting stress) later when the child was age 9. We then examined additive experiences of childcare measures across child ages 1 and 3 on maternal health outcomes. RESULTS:Early inadequate childcare increased odds of later poor maternal overall health (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.11-2.41). All early childcare precarity measures increased odds of maternal depression (insecure childcare [aOR, 1.64; 95% CI, 1.23-2.18]; insecure childcare with missed work [aOR, 1.58; 95% CI, 1.13-2.22]; and inadequate childcare [aOR, 1.75; 95% CI, 1.22-2.51]). Emergency childcare support decreased the odds of adverse maternal health outcomes (poor overall health [aOR, 0.65; 95% CI, 0.48 to 0.88]; depression [aOR, 0.73; 95% CI, 0.54 to 0.99]; and parenting stress [B -0.45; 95% CI, -0.80 to -0.10]). Prolonged experiences had stronger associations with maternal health than shorter experiences. CONCLUSION/CONCLUSIONS:Early childcare precarity has long-term adverse associations with maternal health, and emergency childcare support seems to be favorable for maternal health. These findings highlight childcare precarity as a social determinant of women's health for researchers, clinicians, and decision-makers.

Parental educational attainment significantly shapes child socioeconomic status, potentially influencing various aspects of adolescent health. This study aimed to uncover the relationships between parental education and self-reported adolescent health outcomes, including overall health, mental well-being, and body mass index (BMI). Analyzing data from 1,448 participants in the Future of Families and Child Wellbeing Study, we identified notable associations. Our findings revealed that higher maternal and paternal education correlated with reduced odds of adolescent obesity. Furthermore, increased adolescent academic intention was associated with better overall and mental health in adolescents. Notably, it also played a mediating role in lowering adolescent BMI, thereby potentially explaining the association between parent education and adolescent BMI category (overweight vs. obese). These findings emphasize the significant impact of both parent education and adolescent academic intention on adolescent health. Future research should explore interventions leveraging academic intention to positively influence the health trajectory of adolescents.

OBJECTIVE:Infants with high birthweight have increased risk for adverse outcomes at birth and across childhood. Prenatal risks to healthy food access may increase odds of high birthweight. We tested whether having a poor neighborhood food environment and/or food insecurity had associations with high birthweight. METHODS:We analyzed cross-sectional baseline data in Greenlight Plus, an obesity prevention trial across six US cities (n = 787), which included newborns with a gestational age greater than 34 weeks and a birthweight greater than 2500 g. We assessed neighborhood food environment using the Place-Based Survey and food insecurity using the US Household Food Security Module. We performed logistic regression analyses to assess the individual and additive effects of risk factors on high birthweight. We adjusted for potential confounders: infant sex, race, ethnicity, gestational age, birthing parent age, education, income, and study site. RESULTS:Thirty-four percent of birthing parents reported poor neighborhood food environment and/or food insecurity. Compared to those without food insecurity, food insecure families had greater odds of delivering an infant with high birthweight (adjusted odds ratios [aOR] 1.96, 95% confidence intervals [CI]: 1.01, 3.82) after adjusting for poor neighborhood food environment, which was not associated with high birthweight (aOR 1.35, 95% CI: 0.78, 2.34). Each additional risk to healthy food access was associated with a 56% (95% CI: 4%-132%) increase in high birthweight odds. CONCLUSIONS:Prenatal risks to healthy food access may increase high infant birthweight odds. Future studies designed to measure neighborhood factors should examine infant birthweight outcomes in the context of prenatal social determinants of health.

OBJECTIVE:To examine whether a cultural adaptation of an early childhood obesity prevention program promotes healthy infant feeding practices. STUDY DESIGN/METHODS:Prospective quasi-experimental study of a community-engaged multiphasic cultural adaptation of an obesity prevention program set at a federally qualified health center serving immigrant Chinese American parent-child dyads (N=298). In a group of historical controls, we assessed early infant feeding practices (breastfeeding, sugar-sweetened beverage intake) in 6-month-olds and then the same practices alongside early solid food feeding practices (bottle weaning, fruit, vegetable, sugary or salty snack consumption) in 12-month-olds. After implementation, we assessed these practices in an intervention cohort group at 6 and 12 months. We used cross-sectional groupwise comparisons and adjusted regression analyses to evaluate group differences. RESULTS:At 6 months, the intervention group had increased odds of no sugar-sweetened beverage intake (aOR: 5.69 [95% CI: 1.65, 19.63], p=0.006). At 12 months, the intervention group also had increased odds of no sugar-sweetened beverage intake (aOR: 15.22 [95% CI: 6.33, 36.62], p<0.001), increased odds of bottle weaning (aOR: 2.34 [95% CI: 1.05, 5.23], p=0.03), and decreased odds of sugary snack consumption (aOR: 0.36 [0.18, 0.70], p= 0.003). We did not detect improvements in breastfeeding, fruit, vegetable, or salty snack consumption. CONCLUSION/CONCLUSIONS:A cultural adaptation of a primary care-based educational obesity prevention program for immigrant Chinese American families with low-income is associated with certain healthy infant feeding practices. Future studies should evaluate cultural adaptations of more intensive interventions that better address complex feeding practices like breastfeeding and evaluate long-term weight outcomes.

OBJECTIVE:To examine associations between prolonged early household food insecurity (FI) during pregnancy, infancy, and toddlerhood, and child feeding practices, and the mediating role of dysfunctional parent-child interactions. METHODS:We conducted secondary longitudinal analyses of data from the Starting Early Program (StEP) randomized controlled trial, which studied a primary care-based child obesity prevention program for low-income Hispanic families. Our independent variable was FI, using the USDA Food Security Module, during the third trimester of pregnancy and at child ages 10- and 19-months. Frequency of reported FI was defined by the number of periods with FI (0, 1, 2, or 3). Our dependent variables were feeding practices at child age 28-months using the Comprehensive Feeding Practices Questionnaire. Our mediating variable was dysfunctional parent-child interactions using the Parenting Stress Index subscale at age 19-months. We used linear regression to determine associations between frequency of reported FI and feeding practices adjusting for covariates, and mediation analyses to determine if dysfunctional parent-child interactions mediate these associations. RESULTS:Three hundred and forty four mothers completed assessments at child age 28-months. Of the 12 feeding practices examined, higher frequency of reported FI was positively associated with using food as a reward, restriction of food for weight control, and using food for emotional regulation, and was negatively associated with monitoring of less healthy foods. There was a significant indirect effect of frequency of reported FI on these practices through dysfunctional parent-child interactions. CONCLUSION/CONCLUSIONS:Higher frequency of reported FI was associated with four feeding practices, through dysfunctional parent-child interactions. Understanding these pathways can inform preventive interventions.