Faculty Bibliography

OBJECTIVES.: To determine a set of perinatal characteristics that predict school difficulties in inner-city children by comparing first graders requiring remediation with first graders progressing normally. METHODS.: In a case-control study, maternal surveys about perinatal characteristics were completed for 74 of 90 remedial pre-first and 62 of 90 randomly selected first graders in the Rochester, NY, City School District. RESULTS.: Pre-first graders, as compared with first graders, were more likely to have had birth weights <2,500 g (27% versus 6%). During pregnancy, their mothers were more likely to have been unemployed (73% versus 50%), to have received WIC (68% versus 50%), to have been covered by Medicaid (58% versus 37%), and to have received late or no prenatal care (9% versus 2%). Of these factors, only low birth weight was independently associated with remedial kindergarten placement. CONCLUSION.: Potential risk factors, unfortunately, were fairly prevalent in both groups of inner-city children. While the remedial group was shown to be at greater risk, these findings have little utility in identifying subsets most likely to require remediation at school entry. Because resources aimed at preventing the long-term consequences of early school failure are limited, better means of identifying educational risk at an early age are urgently needed.

The Rochester, New York community has undergone major changes over the past 20 years. Like many other industrial areas, it has seen an erosion of its manufacturing base and a flight of employment opportunities and population from the city to the suburbs. While commonly misperceived as an affluent, white-collar community, in reality there are many families, particularly within the city of Rochester, that are afflicted by some of the most devastating health and social problems facing the United States today.(1) It was against this backdrop that, in 1991, an ongoing effort was begun to develop a system of coordinated health and human services to more effectively address the needs of Rochester's children and families. As a first step, a study was conducted to obtain a detailed picture of the current service system in Rochester; lay out a series of recommendations to improve collaboration and communication; and foster coordinated and integrated services for high-risk youth and families in the community. Key indicators of child and family health were collected, collated, and analyzed, and extensive interviews were conducted with humanservice and medical providers, government officials, education professionals, and parents. This paper describes the process that was used in the study and the recommendations that were included in the final report, which is intended to create a framework for the creation of a comprehensive, needs-based health care system for impoverished and at-risk children and families, including the effective integration of health services into the human service network.

A survey was conducted at a 526-bed community hospital in Rochester, New York, to determine the prevalence of formula advertising and distribution during pregnancy to 136 consecutive intrapartum patients. Women answered a questionnaire about their choice of infant feeding methods and prenatal exposure to formula advertising. Of those who received printed information on infant feeding, 78 percent reported that it was published by a formula company, and 65 percent recalled receiving offers for free formula during their pregnancy. The likelihood of having received such offers was the same in women who planned to breastfeed as in those who planned to formula feed. Thirty-eight percent of women obtained formula through a free offer before their infant's birth. Women who were privately cared for were more likely to have received offers for free formula (p < 0.001) than were women cared for in hospital-affiliated clinics. Ninety percent of women who received free formula prenatally reported their prenatal caregiver as a source of samples. Of samples that women obtained prenatally, 93 percent were from companies that advertise only indirectly through hospitals and physicians, whereas 7 percent were from companies that advertise directly to patients. The prevalence of formula company advertising during the prenatal care of women who deliver in this hospital is high. The continued participation of prenatal caregivers in promotion efforts of formula companies provides a negative or mixed message about the importance of breastfeeding and may be a barrier to its success

BACKGROUND. Despite increasing concerns regarding school readiness, little is known about child health correlates of early school failure among the general child population. The results of this study, conducted to investigate health and social factors associated with early grade retention in a nationally representative sample of children in the United States, are reported here. DESIGN. Analyses of data derived from interviews with parents of 9996 children ages 7 to 17 years who participated in the Child Health Supplement to the 1988 National Health Interview Survey. MAIN OUTCOME MEASURES. History of repeating kindergarten or first grade. RESULTS. Nationally, 7.6% of children repeated kindergarten or first grade. In a logistic regression model, factors independently associated with increased risk of grade retention were: poverty [Odds Ratio (OR) 1.7, 95% confidence interval (CI) 1.4, 2.1], male gender (OR 1.5, CI 1.3, 1.9), low maternal education (OR 1.4, CI 1.1, 1.8); deafness (OR 1.9, CI 1.4, 2.6), speech defects (OR 1.7, CI 1.1, 2.6), low birth weight (OR 1.6, CI 1.2, 2.2), enuresis (OR 1.6, CI 1.1, 2.2), and exposure to household smoking (OR 1.4, CI 1.1, 1.7). High maternal education (OR 0.6 CI 0.4, 0.9) and residence with both biological parents at age 6 years (OR 0.7, CI 0.6, 0.9) were independently associated with a decreased risk of retention. Recurrent otitis media, black race, and low maternal age, although associated with early grade retention in bivariate analyses, were not independently associated with grade retention in a model that controls for these other factors and for the age cohort of the child. Although omitted from the above predictive model because of uncertainty about its temporal relation to early grade retention in this dataset, behavior problems at the time of interview have a strong independent association (OR 1.9, CI 1.5, 2.5) with prior early retention. CONCLUSIONS. This is the first study that uses national data to investigate how health and social factors individually and collectively contribute to early grade retention. It demonstrates that early retention is common, that a number of extremely common child health problems are independently associated with it, and that the magnitude of the heightened risk associated with these problems is similar to that of many of the well-recognized and difficult to change family and social risk factors for early retention. The successful implementations of Pub L 99-457 (The Education for All Handicapped Children Act Amendments of 1986) services in communities nationwide, and the improvement in the educational performance of large numbers of children will be facilitated by pediatricians' advocacy and surveillance for problems that place children at risk for educational failure, and by effective referral to and collaboration with nonpediatric child and family services

The Boston Lead-In-Soil Demonstration Project was a randomized environmental intervention study of the impact of urban soil lead abatement on children's blood lead levels. Lead-contaminated soil abatement was associated with a modest reduction in children's blood lead levels in both phases of the project; however, the reduction in Phase II was somewhat greater than that in Phase I. The combined results from both phases suggest that a soil lead reduction of 2060 ppm is associated with a 2.25 to 2.70 micrograms/dl decline in blood lead levels. Low levels of soil recontamination 1 to 2 years following abatement indicate that the intervention is persistent, at least over the short-term. Furthermore, the intervention appears to benefit most children since no measurable differences in efficacy were observed for starting blood and soil lead level, race, neighborhood, gender, and many other characteristics. However, soil abatement did appear to be more beneficial to children in the higher socioeconomic classes, with low baseline ferritin levels, and who spent time away from home on a regular basis and lived in nonowner occupied housing, and with adults who had lead-related hobbies and almost always washed their hands before meals. Children who lived in apartments with consistently elevated floor dust lead loading levels derived almost no benefit from the soil abatement. It was not possible to separate the effects of the variables that had a beneficial impact on efficacy because they were closely correlated and the number of subjects was small. We recommend that further research be conducted to identify subgroups of children to whom soil lead abatement might be targeted