Faculty Bibliography

INTRODUCTION/BACKGROUND:Parenting self-efficacy (PSE) is correlated with positive parenting and child outcomes, but may be reduced in stressful settings. Community factors affecting PSE are not well understood. The community of Flint, Michigan, endured significant stressors, including the Flint Water Crisis (FWC), and disproportionate effects of the COVID-19 pandemic. This study examines how these superimposed stressors affect PSE in families in Flint. METHODS:This study was a secondary, cross-sectional analysis of 291 infants and caregivers. Baseline surveys included sociodemographics, stress, and PSE. Primary predictors were FWC and COVID-19 distress. Primary outcome was PSE. Bivariate analyses were used to examine the association between FWC and COVID-19 distress with PSE, and multiple linear regression to control for sociodemographics. RESULTS:Both increased COVID-19 distress and FWC distress had significant inverse association with PSE in bivariate analyses, and predicted PSE (COVID-19 distress, β -.18, p <.01, and FWC distress, β -.18, p <.05) in multiple linear regression. A significant interaction was found between FWC distress and COVID-19 distress. Simple slope analyses indicated that COVID-19 distress predicted reduced PSE only for high FWC-distress group (β -.22, p <.01). DISCUSSION/CONCLUSIONS:Results show COVID-19 distress and FWC distress both had independent negative associations with PSE, but FWC distress moderated the effect of COVID-19 distress on PSE, indicating that families more affected by previous stressors were more vulnerable to the effects of COVID-19 distress, while those less affected were resilient to subsequent stressors. Future interventions should target disinvestment, prevent community stressors, and support exposed families.

OBJECTIVE:Supporting early relational health (ERH) positively affects lifelong health. We investigated perspectives of low-income parents of preterm children regarding child factors and parenting behaviors (defined as responsive parenting, structure/routines, and warm parent-child relationship) associated with ERH and factors associated with these behaviors. METHODS:We conducted in-depth, semi-structured interviews with low-income parents of children born preterm between Neonatal Intensive Care Unit (NICU) discharge and age 3 years. We examined perceptions of ERH and used the PRECEDE framework to identify predisposing, enabling, and reinforcing factors affecting parenting behaviors associated with ERH. We developed codes and themes iteratively using a deductive qualitative approach. RESULTS:We interviewed 22 parents of children born 24 to 34 weeks' gestation at 1 to 35 months corrected age. Regarding perspectives on ERH, parents shared that the NICU hospitalization heightens attention to children after discharge and that they feel an intense, sometimes overwhelming, bond with children born preterm. Parents both make accommodations for their preterm children and treat them the same as children born full term. Medical vulnerability affects how they spend time with their children. Regarding predisposing, enabling, and reinforcing factors of parenting behaviors associated with ERH, parents noted that developmental professionals can support relationships, that perceptions of preterm birth affect parents' relationships with their children, and that prior experience parenting preterm and full-term children affects confidence and knowledge of how to form relationships. CONCLUSION/CONCLUSIONS:Adaptation of existing ERH interventions should incorporate ways that NICU hospitalization and views of prematurity inform low-income parents' perceptions and use of parenting behaviors associated with ERH.

OBJECTIVES/OBJECTIVE:To examine the effects of PlayReadVIP, a pediatric primary care intervention promoting early relational health, on child behaviors. STUDY DESIGN/METHODS:A factorial randomized controlled trial enrolled mother-child dyads postpartum. PlayReadVIP was delivered in two phases: birth to 3 years (PlayReadVIP 0-3) and 3 to 5 years (PlayReadVIP 3-5). At enrollment, dyads were assigned to PlayReadVIP 0-3 or control. At age 3, dyads were re-randomized to PlayReadVIP 3-5 or control. Analyses included dyads with a second randomization and complete data on the mediators and child outcomes. In PlayReadVIP, dyads attended one-on-one sessions with a parent coach, in which they received child development information, learning materials, and real-time, strengths-based feedback on brief video recordings of parent-child interactions. Cognitive stimulation and harsh discipline were reported by mothers. Child behaviors were assessed using the Behavior Assessment System for Children, Second Edition. RESULTS:grade. No significant indirect effects through harsh discipline were found. CONCLUSIONS:PlayReadVIP leads to sustained but small improvements in child behaviors by enhancing maternal cognitive stimulation, emphasizing the potential of early intervention in pediatric primary care for promoting child mental health in disadvantaged populations.

Despite well-studied benefits of preventive parenting programs for early child development, various real-world barriers may impede families from engaging in those programs. The current study aims to provide new insights into family engagement by examining enrollment, retention, and involvement and their predictors in an evidence-based universal pediatric primary care parenting program for families with young children. Data (n = 204) were from an ongoing longitudinal randomized controlled trial of PlayReadVIP in Flint, MI. Families (66% Black, 35% White, low socioeconomic status) had high enrollment and retention in the program. As exploratory analyses, random forest models, a machine learning method, identified a multitude of sociodemographic, psychosocial, and contextual predictors of retention and involvement in PlayReadVIP across the first 9 months. As confirmatory analyses, multiple regressions showed that COVID-19 significantly hindered retention (odds ratio = .04; b =  - .30) and involvement (b =  - .31) and that higher parenting self-efficacy was associated with lower retention (odds ratio = .76). Furthermore, the association between COVID-19 and family engagement was moderated by household income, suggesting that families with the highest economic risks were less likely to attend and be actively involved in sessions during the pandemic. This study addresses important research gaps by focusing on multiple aspects of family engagement in a pediatric program during infancy, assessing whether experiencing contextual adversity hinders or motivates engagement, and employing a machine learning method. These findings have crucial implications for designing and implementing early childhood prevention parenting programs to more effectively engage families with higher needs.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Despite longstanding efforts to design, implement, and study parenting interventions early in life to address disparities in school readiness, gaps remain related to understanding their long-term effects and pathways of influence on child development. Here we describe sustained impacts at child age 6 of the innovative, tiered birth to age 3 Smart Beginnings (SB) model. METHODS:We performed a single-blind, 2-site randomized clinical trial of the SB model. SB integrates PlayReadVIP, a universal, pediatric primary care-based program, and Family Check-Up, a targeted secondary home-based parenting intervention. Mother-infant dyads (N = 403) were randomized at birth to standard pediatric care or the SB model. In line with SB's theory of change that supporting parents will promote their children's development, single and serial mediation pathways evaluated intervention effects of SB on age 6 child academic skills through parental cognitive stimulation at age 2 and child academic functioning at age 4. RESULTS:We found significant single and serially mediated indirect effects of SB on academic outcomes through parental cognitive stimulation in toddlerhood and preacademic skills in preschool. The total indirect pathways were positive and statistically significant for all academic outcomes at age 6, including receptive vocabulary (effect size [ES] = 0.04, P = .04), oral comprehension (ES = 0.05, P = .04), letter-word recognition (ES = 0.04, P = .04), phonemic decoding (ES = 0.04, P = .04), and applied problems (ES = 0.05, P = .04). CONCLUSIONS:Findings build on the demonstrated scalability of the SB model, support the cumulative process of academic functioning in childhood, and offer a promising model to address disparities early in life.

BACKGROUND:Eleven years have passed since the 2014 Flint water crisis (FWC), yet many voices still go unheard. There is limited evidence of the impact of the FWC on maternal health. This paper used a cross-sectional study design to survey 152 women enrolled in the Supporting Parents and Raising Resilient Kids (SPARRK) study in Flint, Michigan to examine racial differences in women's perceptions of their overall health pre- and post-FWC, perceived maternal health services, and explore the interaction of race and living in Flint on maternal morbidity. METHODS:Perceived maternal health was defined using the Centers for Disease Control and Prevention's 21 Severe Maternal Morbidity (SMM) diagnosis codes. SMM were obtained via questionnaire. Logistic regression analyses were performed to identify factors associated with SMM within two domains: (1) overall health pre- and post-FWC and (2) perceived maternal health care received during birth. RESULTS:There were 17 cases of SMM in which Black women accounted for 62.5% of these cases. Perceived quality of care was overall positive; yet, perceived overall health decreased post-FWC for all women. The odds of SMM were 6 times higher for those who had a college degree or higher. CONCLUSION/CONCLUSIONS:In the predominately Black city of Flint, race was not a significant factor in the perception of health and quality of care. Surprisingly, educational attainment was significantly associated with a 6-time increase in odds of experiencing an SMM. More research is needed to examine the association of patient-provider perception of quality care and education on maternal health outcomes.

We combined data from five cohorts of mothers of young children across three cities to understand how COVID-19 affected parenting among predominantly Black and Latine families with low incomes. We examined whether mothers reported that their parenting got worse, got better, or stayed the same; drew on a qualitative substudy to identify themes describing parenting experiences; and used quantitative data to identify psychosocial characteristics associated with changes in parenting. Forty-four percent of mothers reported their parenting stayed the same after COVID-19 onset, 32% reported improvements, and 24% reported their parenting got worse. Qualitative data illustrated that mothers whose parenting got better spent more and higher-quality time with children, whereas mothers whose parenting got worse did not maintain family routines, had financial worries, and exhibited harsh responses to child problem behaviors. Quantitative data showed that depression, social support, COVID-19-related distress, and parenting self-agency were all associated with reported changes in parenting.

This study examined longitudinal associations between maternal mindful parenting and child social-emotional, behavioral, and language development. Maternal mindful parenting at 18 months was tested for associations with concurrent observed maternal responsivity and lack of punishment toward the child and as a predictor of child internalizing symptoms, externalizing symptoms, social competence and productive language 6 months later, independent of maternal depressive symptoms (a known predictor of both parenting and child outcomes). We also tested whether child negative emotionality (NE) moderated associations between mindful parenting and child outcomes. Participants (N = 316 mothers) were low-income (mean annual income = $19,024), racially and ethnically diverse mothers (48.4% Black; 43.0% Latinx) recruited from Pittsburgh, PA and New York City, NY. Higher mindful parenting was concurrently associated with higher observed maternal responsiveness toward the child and longitudinally associated with all four child outcomes in expected directions; maternal depression was a significant predictor of child internalizing and externalizing symptoms. Contrary to hypotheses, at moderately high levels of child NE, the positive effects of mindful parenting on child outcomes were attenuated. Results provide preliminary evidence that mindful parenting is meaningfully associated with parenting behaviors and early childhood developmental outcomes above and beyond symptoms of maternal depression.

UNLABELLED:Social-emotional competence is critical to children's social and school success, prompting interest in understanding factors that promote these skills prior to elementary-school. Cognitive stimulation (e.g., reading, playing) is related to preschool children's social outcomes; However, few studies have examined these associations earlier, or determined whether interventions that encourage cognitive stimulation may enhance children's early social-emotional competencies either directly, or through impact on these behaviors. The present study examined whether cognitive stimulation in infancy predicted social competence in toddlerhood and the impact of a positive parenting intervention on these child outcomes. Mother-infant dyads in the Smart Beginnings (SB) RCT (primarily Hispanic/Latino or Black and from low-income backgrounds) were randomly assigned to treatment or control. SB integrates universal primary prevention in pediatric primary care (PlayReadVIP); and targeted/secondary prevention through home visiting (Family Check-Up). Mothers' cognitive stimulation at 6 months significantly predicted children's social-emotional competence at 24 months. Although there was no direct effect of SB on children's social-emotional competence, there was an indirect effect on children's social competence through maternal cognitive stimulation. Findings suggest that associations between cognitive stimulation and children's social-emotional competence emerge earlier than previously shown, and that positive parenting interventions can support early social-emotional competence through impact on cognitive stimulation. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov identifier: NCT02459327.

Children living in the rural US are more likely to live below the poverty line than their urban counterparts, and rural poverty is associated with greater disparities than urban poverty for many indicators of health, behavior, and school readiness. However, rural communities have often been overlooked in research focused on prevention of disparities in child development. Early Relational Health (ERH), which includes positive parenting practices and parent-child relationship quality, can support family resilience and buffer the consequences of racism, poverty, and related stressors on child development in families across geographical regions. In this narrative review, we describe the unique contextual factors within rural communities that facilitate and impose barriers to ERH and demonstrate the need for implementation and study of interventions that can support ERH in rural families. We describe platforms that have previously been used to deliver interventions in rural settings and recognize pediatric primary care as an underutilized context for supporting ERH and reducing disparities in child development in rural populations. Finally, we provide examples of key strategies that can reduce barriers to population-level delivery of interventions to rural families including improving access and providing culturally appropriate programming. Additional research is needed to address core gaps in the knowledge base related to prevention of inequities in rural populations through supporting ERH.