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Promoting Cognitive Stimulation in Parents across Infancy and Toddlerhood: A Randomized Clinical Trial

Miller, Elizabeth B; Roby, Erin; Zhang, Yudong; Coskun, Lerzan; Rosas, Johana M; Scott, Marc A; Gutierrez, Juliana; Shaw, Daniel S; Mendelsohn, Alan L; Morris-Perez, Pamela A
OBJECTIVE:To test the impact of the fully integrated Smart Beginnings model on parental support of cognitive stimulation from 6-24 months across infancy and toddlerhood. STUDY DESIGN/METHODS:Single-blind, two-site randomized clinical trial of the SB intervention. Enrollment took place at birth in postpartum units of hospitals in New York City and Pittsburgh, PA with a consecutive sample of 403 mother-infant dyads. SB combines Video Interaction Project (VIP) - 14-session universal primary prevention program delivered in the pediatric clinic at the time of well-child visits birth-36 months - with potential for Family Check-Up (FCU) - 3-4-session targeted secondary prevention home-visiting program. The principal outcome was parental support of cognitive stimulation assessed via parent survey and video-recorded observations of parent-child interactions. Ordinary least squares and mixed effects regressions were conducted. RESULTS:Families were mostly Black/African-American (50%) or Latinx (42%); all were Medicaid eligible (100%). SB significantly promoted cognitive stimulation during infancy and toddlerhood for most survey outcomes across time, including StimQ common total (Effect Size [ES]=.25, p=.01) and READ Quantity (ES=.19, p=.04) and Quality (ES=.30, p=.001). For the observations, the impact of SB varied by time, with significant impacts at 6 (ES=.37-.40, p<.001) and 24 (ES=.27-.30, p<.001) months, but not 18 months. CONCLUSIONS:SB positively promotes cognitive stimulation from infancy through toddlerhood using the integrated model. This study adds to the body of research showing preventive interventions in pediatric primary care and home visiting can support early relational health including parental support of cognitive stimulation.
PMID: 36481243
ISSN: 1097-6833
CID: 5383142

Spanish Instruction in Head Start and Dual Language Learners' Academic Achievement

Miller, Elizabeth B
Data from the Head Start Impact Study (N = 1,141) and the Head Start Family and Child Experiences Survey, 2009 Cohort (N = 825) were used to investigate whether Spanish instruction in Head Start differentially increased Spanish-speaking Dual Language Learners' (DLLs) academic achievement. Although hypothesized that Spanish instruction would be beneficial for DLLs' early literacy and math skills, results from residualized growth models showed there were no such positive associations. Somewhat surprisingly, DLL children instructed in Spanish had higher English receptive vocabulary skills at the end of the Head Start year than those not instructed, with children randomly assigned to Head Start and instructed in Spanish having the highest scores. Policy implications for Head Start-eligible Spanish-speaking DLLs are discussed.
PMCID:5722255
PMID: 29230077
ISSN: 0193-3973
CID: 4529382

Do the effects of head start vary by parental preacademic stimulation?

Miller, Elizabeth B; Farkas, George; Vandell, Deborah Lowe; Duncan, Greg J
Data from the Head Start Impact Study (N = 3,185, age = 3-4 years) were used to determine whether 1 year of Head Start differentially benefited children from homes with high, middle, and low levels of parental preacademic stimulation on three academic outcome domains-early math, early literacy, and receptive vocabulary. Results from residualized growth models showed positive impacts of random assignment to Head Start on all three outcomes, and positive associations between parental preacademic stimulation and academic performance. Two moderated effects were also found. Head start boosted early math skills the most for children receiving low parental preacademic stimulation. Effects of Head Start on early literacy skills were largest for children receiving moderate levels of parental preacademic stimulation. Implications for Head Start are discussed.
PMCID:4107068
PMID: 24597729
ISSN: 1467-8624
CID: 4529332

Predictors of television at bedtime and associations with toddler sleep and behavior in a medicaid-eligible, racial/ethnic minority sample

Miller, Elizabeth B; Canfield, Caitlin F; Wippick, Helena; Shaw, Daniel S; Morris, Pamela A; Mendelsohn, Alan L
This study examined predictors of TV use at bedtime and associations with toddlers' sleep and behavior using data from the Smart Beginnings study with 403 Medicaid-eligible, racial/ethnic minority participants from two cities in the United States. We first estimated predictors of TV use at bedtime at 18 months. We then examined whether TV at bedtime was associated with concurrent parent-report of nighttime sleep duration and quality, and later problem behavior at 24 months. Results showed that around half of the sample reported using TV at bedtime with their toddlers, and particularly first-time mothers and those receiving public assistance. We also found that use of TV at bedtime was related to concurrent sleep issues and increases in later problem behavior. Mediational path analyses revealed that TV at bedtime affected behavior via sleep quality. Despite the heterogeneity within this Medicaid-eligible sample, the results underscore the universally harmful effects of TV use at bedtime and lend support for structuring nighttime routines for toddlers to promote better sleep and behavioral outcomes.
PMID: 35272177
ISSN: 1934-8800
CID: 5190442

Improving Parent-Child Interactions in Pediatric Health Care: A Two-Site Randomized Controlled Trial

Roby, Erin; Miller, Elizabeth B; Shaw, Daniel S; Morris, Pamela; Gill, Anne; Bogen, Debra L; Rosas, Johana; Canfield, Caitlin F; Hails, Katherine A; Wippick, Helena; Honoroff, Julia; Cates, Carolyn B; Weisleder, Adriana; Chadwick, Kelly A; Raak, Caroline D; Mendelsohn, Alan L
BACKGROUND AND OBJECTIVES/OBJECTIVE:Heterogeneity in risk among low-income families suggests the need for tiered interventions to prevent disparities in school readiness. Smart Beginnings (SB) integrates two interventions: Video Interaction Project (VIP) (birth to 3 years), delivered universally to low-income families in pediatric primary care, and Family Check-Up (6 months to 3 years), targeted home visiting for families with additional family risks. Our objective was to assess initial SB impacts on parent-child activities and interactions at 6 months, reflecting early VIP exposure. METHODS:Two-site randomized controlled trial in New York City (84% Latinx) and Pittsburgh (81% Black), with postpartum enrollment and random assignment to treatment (SB) or control. At 6 months, we assessed parent-child interactions through surveys (StimQ, Parenting Your Baby) and observation (video-recorded play, coded by using Parent-Child Interaction Rating Scales - Infant Adaptation). RESULTS:< .001). Thus, significant effects emerged across a broad sample by using varied methodologies. CONCLUSIONS:Findings replicate and extend previous VIP findings across samples and assessment methodologies. Examining subsequent assessments will determine impacts and feasibility of the full SB model, including potential additive impacts of Family Check-Up for families at elevated risk.
PMID: 33608413
ISSN: 1098-4275
CID: 4793982

Pediatric primary care and partnerships across sectors to promote early child development

Roby, Erin; Shaw, Daniel S; Morris, Pamela; Canfield, Caitlin F; Miller, Elizabeth B; Dreyer, Benard; Klass, Perri; Ettinger, Anna; Miller, Elizabeth; Mendelsohn, Alan L
Poverty remains a critical predictor of children's school readiness, health and longer term outcomes. Early relational health (ERH) (i.e., parenting practices and relationship quality) mediates the impact of poverty on child development, and thus has been the focus of many parenting interventions. Despite the documented efficacy of parenting interventions at reducing poverty-related disparities in child health and development, several key barriers prevent achieving population-level reach to families with young children. In the current paper we highlight several of these barriers including gaining population-level access to young children and families, reaching families only through single points of access, addressing the significant heterogeneity of risk that exists among families living in poverty, as well as addressing each of these barriers in combination. We suggest that understanding and confronting these barriers will allow family-centered interventions to more effectively address issues related to ERH at a population level, which in turn will reduce poverty-related disparities in child development.
PMID: 33352322
ISSN: 1876-2867
CID: 4726522

Collateral benefits from a school-readiness intervention on breastfeeding: A cross-domain impact evaluation

Miller, Elizabeth B; Whipps, Mackenzie D M; Bogen, Debra L; Morris, Pamela A; Mendelsohn, Alan L; Shaw, Daniel S; Gross, Rachel S
This study evaluated the collateral, or unanticipated, impacts of Smart Beginnings (SB), a two-site, tiered intervention designed to promote responsive parenting and school readiness, on breastfeeding intensity in a low-income sample. Impact analyses for the SB intervention were conducted using an intent-to-treat design leveraging a two-arm random assignment structure. Mothers assigned to the SB intervention group were more than three times more likely to give breastmilk as the only milk source at infant age 6 months than mothers assigned to the control group at one site, an effect not evident at the other study site. As development and growth are the two most salient domains of child health, understanding how interventions impact subsequent parenting practices across both domains is critical to address long-term economic and racial/ethnic disparities. Implications of the findings are discussed for improving the efficacy of interventions based on paediatric primary care.
PMID: 36218286
ISSN: 1740-8709
CID: 5348182

Does Head Start differentially benefit children with risks targeted by the program's service model?

Miller, Elizabeth B; Farkas, George; Duncan, Greg J
Data from the Head Start Impact Study (N = 3540) were used to test for differential benefits of Head Start after one program year and after kindergarten on pre-academic and behavior outcomes for children at risk in the domains targeted by the program's comprehensive services. Although random assignment to Head Start produced positive treatment main effects on children's pre-academic skills and behavior problems, residualized growth models showed that random assignment to Head Start did not differentially benefit the pre-academic skills of children with risk factors targeted by the Head Start service model. The models showed detrimental impacts of Head Start for maternal-reported behavior problems of high-risk children, but slightly more positive impacts for teacher-reported behavior. Policy implications for Head Start are discussed.
PMCID:4563874
PMID: 26379369
ISSN: 0885-2006
CID: 4529352

Beyond language: Impacts of shared reading on parenting stress and early parent-child relational health

Canfield, Caitlin F; Miller, Elizabeth B; Shaw, Daniel S; Morris, Pamela; Alonso, Angelica; Mendelsohn, Alan L
This study examined the interrelated and longitudinal impacts of parent-child shared book reading, parenting stress, and early relational health, as measured by both parental warmth and parent sensitivity, from infancy to toddlerhood. To extend findings from previous studies of collateral effects that have been conducted in parenting interventions, we examined parenting behaviors in a broader context to determine whether shared book reading would confer collateral benefits to the parent and parent-child relationship beyond those expected (i.e., language and literacy). It was hypothesized that positive parent-child interactions, such as shared reading, would have positive impacts on parent outcomes such as parenting stress, parental warmth, and sensitivity. The sample consisted of 293 low-income mothers and their children who participated in a randomized controlled trial. Shared book reading, parenting stress, and parental warmth were assessed when children were 6 and 18 months old. We computed a series of cross-lagged structural equation models to examine longitudinal interrelations among these three factors. Results indicated that shared book reading at 6 months was associated with increases in observed and reported parental warmth and observed sensitivity and decreases in parenting stress at 18 months, controlling for baseline risk factors and treatment group status. These findings suggest that early parent-child book reading can have positive collateral impacts on parents' stress and the parent-child relationship over time. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
PMID: 32352828
ISSN: 1939-0599
CID: 4412682

Breastfeeding Behaviors and Maternal Interaction Quality in a Low-Income, Ethnic Minority Population

Whipps, Mackenzie D M; Miller, Elizabeth B; Bogen, Debra L; Mendelsohn, Alan L; Morris, Pamela A; Shaw, Daniel; Gross, Rachel S
OBJECTIVE:To examine the associations between breastfeeding intensity and underexplored features of maternal-child interaction quality over and above the influence of breastfeeding initiation. METHODS:The current study leveraged an on-going, multisite randomized controlled trial of a tiered parenting program for 462 Medicaid-eligible mothers and their infants in the United States. We examined whether breastfeeding intensity and exclusivity was associated with observed maternal sensitivity, intrusiveness, and detachment, as well as self-reported maternal verbal responsiveness, 6 months infant age. Analyses controlled for breastfeeding initiation, demographics, and early parenting experiences. RESULTS:Higher intensity breastfeeding at 6 months was significantly related to higher maternal sensitivity (β = 0.12, p = 0.004) and lower maternal intrusiveness (β = -0.10, p = 0.045). There was no significant association between breastfeeding intensity at 6 months and detachment (β = -0.02, no significant [ns]) or self-reported verbal responsiveness (β = 0.11, ns). Results were the same when intensity was measured as a dichotomous indicator for exclusive breastfeeding. Effect sizes were small-to-moderate, ranging from Cohen's d = 0.26 to 0.31. Associations did not vary by site, race/ethnicity, infant difficultness, or household poverty. CONCLUSION/CONCLUSIONS:The finding that breastfeeding intensity was significantly and independently associated with maternal sensitivity and intrusiveness is novel in the literature on low-income families from the United States. These findings have implications for breastfeeding promotion strategies and indicate that future research should explore synergistic or spillover effects of interventions aimed at maternal-child interaction quality into the infant feeding domain, particularly in the primary care setting.
PMID: 31613842
ISSN: 1536-7312
CID: 4140392