Faculty Bibliography

BACKGROUND: The Global Alliance for Chronic Diseases comprises the majority of the world's public research funding agencies. It is focussed on implementation research to tackle the burden of chronic diseases in low- and middle-income countries and amongst vulnerable populations in high-income countries. In its inaugural research call, 15 projects were funded, focussing on lowering blood pressure-related disease burden. In this study, we describe a reflexive mapping exercise to identify the behaviour change strategies undertaken in each of these projects. METHODS: Using the Behaviour Change Wheel framework, each team rated the capability, opportunity and motivation of the various actors who were integral to each project (e.g. community members, non-physician health workers and doctors in projects focussed on service delivery). Teams then mapped the interventions they were implementing and determined the principal policy categories in which those interventions were operating. Guidance was provided on the use of Behaviour Change Wheel to support consistency in responses across teams. Ratings were iteratively discussed and refined at several group meetings. RESULTS: There was marked variation in the perceived capabilities, opportunities and motivation of the various actors who were being targeted for behaviour change strategies. Despite this variation, there was a high degree of synergy in interventions functions with most teams utilising complex interventions involving education, training, enablement, environmental restructuring and persuasion oriented strategies. Similar policy categories were also targeted across teams particularly in the areas of guidelines, communication/marketing and service provision with few teams focussing on fiscal measures, regulation and legislation. CONCLUSIONS: The large variation in preparedness to change behaviour amongst the principal actors across these projects suggests that the interventions themselves will be variably taken up, despite the similarity in approaches taken. The findings highlight the importance of contextual factors in driving success and failure of research programmes. Forthcoming outcome and process evaluations from each project will build on this exploratory work and provide a greater understanding of factors that might influence scale-up of intervention strategies.

This study examines preadolescents' reports of risk-taking as predicted by two different, but related inhibitory control systems involving sensitivity to reward and loss on the one hand, and higher order processing in the context of cognitive conflict, known as executive functioning (EF), on the other. Importantly, this study examines these processes with a sample of inner-city, low-income preadolescents and as such examines the ways in which these processes may be related to risky behaviors as a function of children's levels of both concurrent and chronic exposure to household poverty. As part of a larger longitudinal study, 382 children (ages 9 -11) provided a self-report of risky behaviors and participated in the Iowa Gambling task, assessing bias for infrequent loss (preference for infrequent, high magnitude versus frequent, low magnitude loss) and the Hearts and Flowers task assessing executive functioning. Results demonstrated that a higher bias for infrequent loss was associated with higher risky behaviors for children who demonstrated lower EF. Furthermore, bias for infrequent loss was most strongly associated with higher risk-taking for children facing highest levels of poverty. Implications for early identification and prevention of risk-taking in inner-city preadolescents are discussed.

Several studies have investigated associations between socioeconomic status (SES) and indicators of children's physiological and cognitive self-regulation. Although objective measures of family SES may be good proxies for families' experiences of disadvantage, less is known about subjective aspects of families' experiences. We hypothesize that subjective social status (SSS) and perceived stress may be important independent predictors of children's stress physiology and executive functioning (EF). Eighty-two children from diverse SES backgrounds were administered EF measures and provided saliva samples for cortisol assay. Caregivers reported on objective SES, SSS, and perceived stress. Results suggest that SES and SSS are both independently and positively related to EF. In models predicting stress physiology, higher perceived stress was associated with lower baseline cortisol. Moreover, SES and age interacted to predict cortisol levels such that among younger children, lower SES was associated with higher cortisol, whereas among older children, lower SES was associated with lower cortisol. Results highlight the importance of considering both objective and subjective indicators of families' SES and stressful experiences in relation to multiple aspects of children's self-regulation.

Numerous studies demonstrate that the Methionine variant of the catechol-O-methyltransferase Val158Met polymorphism, which confers less efficient catabolism of catecholamines, is associated with increased focal activation of prefrontal cortex (PFC) and higher levels of executive function abilities. By and large, however, studies of COMT Val158Met have been conducted with adult samples and do not account for the context in which development is occurring. Effects of early adversity on stress response physiology and the inverted U shape relating catecholamine levels to neural activity in PFC indicate the need to take into account early experience when considering relations between genes such as COMT and executive cognitive ability. Consistent with this neurobiology, we find in a prospective longitudinal sample of children and families (N = 1292) that COMT Val158Met interacts with early experience to predict executive function abilities in early childhood. Specifically, the Valine variant of the COMT Val158Met polymorphism, which confers more rather than less efficient catabolism of catecholamines is associated with higher executive function abilities at child ages 48 and 60 months and with faster growth of executive function for children experiencing early adversity, as indexed by cumulative risk factors in the home at child ages 7, 15, 24, and 36 months. Findings indicate the importance of the early environment for the relation between catecholamine genes and developmental outcomes and demonstrate that the genetic moderation of environmental risk is detectable in early childhood. (c) 2015 Wiley Periodicals, Inc. Dev Psychobiol 57: 833-841, 2015.

Cortisol output in response to emotion induction procedures was examined at child age 24 months in a prospective longitudinal sample of 1,292 children and families in predominantly low-income and nonurban communities in two regions of high poverty in the United States. Multilevel analysis indicated that observed emotional reactivity to a mask presentation but not a toy removal procedure interacted with sensitive parenting to predict cortisol levels in children. For children experiencing high levels of sensitive parenting, cortisol output was high among children exhibiting high emotional reactivity and low among children exhibiting low emotional reactivity. For children experiencing low levels of sensitive parenting, cortisol output was unrelated to emotional reactivity.

Path analysis was used to investigate the longitudinal associations among parenting and children's executive function and externalizing behavior problems from 36 to 90 months of age in the Family Life Project (N = 1,115), a study of child development in the context of rural poverty. While controlling for stability in the constructs, semistructured observations of parenting prospectively predicted performance on a battery of executive function tasks and primary caregivers' reports of externalizing behavior. Furthermore, the association between early parenting and later externalizing behavior was longitudinally mediated by executive function, providing support for a process model in which sensitive parenting promotes children's self-regulation, which in turn reduces children's externalizing behavior.

The relation of self-regulation measured prior to school entry to developing math and reading ability in prekindergarten through the second grade was examined in a prospective longitudinal sample of 1,292 children and families in predominantly rural and low-income communities in 2 regions of high poverty in the United States. Direct assessments of executive function, effortful control, and stress response physiology (indexed by resting levels of cortisol and alpha amylase obtained from saliva) were measured at child age 48 months and parents and teachers reported on children's effortful control using temperament rating scales at child age approximately 60 months. Math and reading ability, as measured by the Woodcock-Johnson III applied problems and letter-word subtests, respectively, were measured at prekindergarten through the second grade. Effects for self-regulation measures were seen primarily for initial level and to some extent growth in both mathematics and reading, even when controlling for family demographic characteristics that represent relevant selection factors into higher levels of both self-regulation and academic achievement. These effects persisted for mathematics but not for reading with the inclusion of child cognitive abilities, vocabulary, and speed of processing measured in prekindergarten, concurrent with the first time point for the academic measures. Results are interpreted as indicating a role for self-regulation in learning ability generally, likely through support for attention and reasoning abilities that are most specific to the assessment of mathematics in this analysis. Implications for instruction and for assessment and the best ways to support the development of early math and reading ability for children at risk for school failure are discussed.

This study evaluated continuity and change in maternal-child hypothalamic-pituitary-adrenal axis attunement in early childhood. Participants were drawn from a prospective study of 1,292 mother-child dyads, which were racially diverse, predominantly low-income, and non-urban. Child focused stress tasks designed to elicit anger, fear, and frustration were administered during early infancy, later infancy, and toddlerhood. Mothers' and children's saliva samples (later assayed for cortisol) were collected before and after the tasks. The strength of mother-child adrenocortical attunement was conserved across infancy and toddlerhood. The magnitude of maternal-child adrenocortical attunement decreased in response to the child-focused stress tasks. Maternal sensitivity and the child's task-related emotional reactivity moderated adrenocortical attunement across the task, with greater maternal sensitivity during a free-play, and lower levels of child emotional reactivity during the stress tasks, stabilizing attunement from pre- to post-task levels. The findings advance our understanding of individual differences in the social regulation of adrenocortical activity in early childhood.

The following prospective longitudinal study considers the ways that protracted exposure to verbal and physical aggression between parents may take a substantial toll on emotional adjustment for 1,025 children followed from 6 to 58 months of age. Exposure to chronic poverty from infancy to early childhood as well as multiple measures of household chaos were also included as predictors of children's ability to recognize and modulate negative emotions in order to disentangle the role of interparental conflict from the socioeconomic forces that sometimes accompany it. Analyses revealed that exposure to greater levels of interparental conflict, more chaos in the household, and a higher number of years in poverty can be empirically distinguished as key contributors to 58-month-olds' ability to recognize and modulate negative emotion. Implications for models of experiential canalization of emotional processes within the context of adversity are discussed.

Research on the development of self-regulation in young children provides a unifying framework for the study of school readiness. Self-regulation abilities allow for engagement in learning activities and provide the foundation for adjustment to school. A focus on readiness as self-regulation does not supplant interest in the development of acquired ability, such as early knowledge of letters and numbers; it sets the stage for it. In this article, we review research and theory indicating that self-regulation and consequently school readiness are the product of integrated developmental processes at the biological and behavioral levels that are shaped by the contexts in which development is occurring. In doing so, we illustrate the idea that research on self-regulation powerfully highlights ways in which gaps in school readiness and later achievement are linked to poverty and social and economic inequality and points the way to effective approaches to counteract these conditions.