Positive Early Childhood Experiences and School Readiness among US Preschoolers.

OBJECTIVES: To characterize the relationship between positive early childhood experiences (PECEs) and school readiness, and assess whether the PECEs-school readiness relationship was robust to and/or differed across levels of adverse childhood experiences (ACEs). METHODS: We analyzed national data on children ages 3-5 from 2016 to 2020 (n = 26 871) to examine associations between key PECE domains (nurturing relationships, home learning opportunities, safe and stable environments, and family routines) with being on track for school readiness, defined using a pilot, multidimensional measure called "healthy and ready to learn". Weighted univariate, bivariate, and multivariable analyses were conducted to generate nationally representative estimates. Multivariable models adjusted for sociodemographic factors and were assessed both with and without cumulative ACE exposure. RESULTS: Two-fifths of children were healthy and ready to learn. Exposure to PECEs was associated with higher school readiness, irrespective of relative ACE exposure. Compared with those with low PECEs, children with moderate (aOR, 2.19; 95% CI, 1.86-2.58) and high (aOR, 4.37; 95% CI, 3.58-5.34) PECEs had greater odds for being healthy and ready to learn, net of both sociodemographic factors and ACE exposure. Significant associations were robust across demographic groups (eg, race and ethnicity), ACE levels, and ACE types (eg, parental incarceration). CONCLUSIONS: Increasing PECEs correspond with greater likelihood of possessing capacities key for school functioning, even amidst ACEs. In concert with efforts to ameliorate early life trauma, caregivers, health care providers, educators, and systems can consider boosting PECEs to foster healthy development in childhood and beyond.

Health and care utilization among youth with a history of parental incarceration and homelessness.

INTRODUCTION: Despite widespread recognition of the health and social risks posed by parental incarceration (PI) and homelessness, these challenges are rarely considered in unison. We sought to (a) assess the experiences of homelessness among youth with and without a history of PI and (b) compare the health and healthcare utilization among youth with a combined history of PI and homelessness. METHOD: Examining data from eighth-, ninth-, and 11th-grade public school participants in the 2019 Minnesota Student Survey (N = 110,904), we calculated univariate and multivariate analyses to characterize the health status and care utilization of youth who have experienced PI, past-year homelessness, or both. RESULTS: We observed higher prevalence of homelessness among youth with a history of PI compared to those without. The group with dual PI-homelessness experience had a higher proportion of youth that were younger, male, and non-White; and living in poverty or urban areas compared to youth with PI history only. Even after accounting for demographic factors, the dual PI-homelessness group evidenced higher expected odds for several physical health conditions (e.g., asthma, diabetes), and differences in care utilization indicators relative to individual PI and homelessness groups. DISCUSSION: Findings suggest that PI may be overrepresented among recently homeless youth and that youth with such dual experience possess distinct, and often elevated, health service needs. Health, education, housing, and other systems may need intersectoral strategies to better identify and support this at-risk subset of youth through clinical and policy approaches. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Youth at the intersection of parental incarceration and foster care: Examining prevalence, disparities, and mental health.

BACKGROUND: While there are various pathways by which children experience parental incarceration or foster care, involvement in either system is associated with adverse health outcomes. Despite co-occurring risk factors for parental incarceration and foster care, little is known about the prevalence or characteristics of youth navigating both of these experiences. OBJECTIVES: This study details the prevalence of youth at the intersection of parental incarceration and foster care, their demographic characteristics, and heterogeneity in their mental health. PARTICIPANTS AND SETTING: Data come from the 2019 Minnesota Student Survey with 112,157 eighth-, ninth-, and eleventh-grade students. METHODS: Logistic regression with interactions between parental incarceration and foster care predict associated odds of youth's anxiety and depression; self-injurious behavior, suicidal ideation and attempt; and mental health diagnoses and treatment. RESULTS: Nearly 2 % of students experienced both parental incarceration and foster care, with a disproportionate number of those identifying as youth of color, experiencing poverty, and/or living in rural communities. Both parental incarceration and foster care were separately linked with poor mental health, yet experiencing both was associated with higher odds of anxiety, depression, self-injury, suicidal ideation, suicide attempt, diagnosis, and treatment. Youth with proximal multiplicative exposure (recent foster care and current parental incarceration) reported the most adverse mental health symptoms. CONCLUSION: The study emboldens what is known about the inequitable distribution of parental incarceration and foster care. These findings highlight the association between dual-systems-impacted youth and mental health indicators, with important implications for increasing access to mental health services while simultaneously calling for systems change.

Depressive Symptoms among Pregnant and Postpartum Women in Prison.

INTRODUCTION: Women in prison experience high rates of mental and physical health problems, and pregnant and postpartum women in prison may be particularly vulnerable. Very few studies have examined depressive symptoms among women who are pregnant and give birth in prison. We assessed depressive symptoms longitudinally from pregnancy into the postpartum period in a sample of 58 women who gave birth in prison. We also considered whether incarceration-related factors (length of time incarcerated while pregnant, remaining length of sentence to serve after birth) were associated with depressive symptoms. METHODS: Data were collected as part of an ongoing evaluation of a prison-based pregnancy and parenting support program at one women's state prison. At prenatal and postpartum visits with their doula, women completed the Patient Health Questionnaire-9 (PHQ-9), a measure of depressive symptom severity. RESULTS: More than one-third of our sample of women who were incarcerated and gave birth in custody met criteria for moderate to severe depression on the PHQ-9 during pregnancy or the postpartum period. Women who faced longer periods of incarceration following birth and separation from their newborns reported higher levels of postpartum depressive symptoms. DISCUSSION: Findings have implications for practice and policy aimed at supporting the mental health needs of women who are pregnant in prison, particularly those women who give birth in custody and are separated from their newborns.

The Health and Development of Young Children Who Witnessed Their Parent's Arrest Prior to Parental Jail Incarceration.

Most U.S. incarceration occurs in jails, with more than 10 million annual admissions, and most individuals in jail are parents of minor children. In this short-term longitudinal study, we examined the health and development of young children who did or did not witness their parent's arrest prior to parental jail incarceration. 228 individuals in 76 triads (incarcerated parents, children, at-home caregivers) were enrolled from four jails in two states. Jailed parents and caregivers reported on whether the child witnessed the parent's arrest or crime. Children's caregivers completed questionnaires about children's emotional symptoms during the prior 6 months and demographics, as well as children's emotional reactions to separation from the parent and child health at the initial assessment and 2 weeks later. Trained researchers conducted a developmental assessment with children while waiting to visit parents. Results of regression-based moderated mediation analyses indicated that when their emotional symptoms were high, children who witnessed parental arrest were more likely to have poorer health initially and more intense negative reactions to the parent leaving for jail. In addition, when children's general emotional symptoms were low, children who witnessed their parent's arrest were more likely to exhibit developmental delays, especially in their early academic skills, compared to children who did not witness the arrest. Witnessing the parent's crime related to missed milestones in social and adaptive development. Findings have implications for policies regarding safeguarding children during parental arrest and referrals for health- and development-promotion services following parental criminal justice system involvement.

Multisite randomized efficacy trial of educational materials for young children with incarcerated parents.

Although children with incarcerated parents exhibit more behavior problems, health concerns, and academic difficulties than their peers, few interventions or resources are available to support affected children. This randomized, controlled, multisite efficacy trial evaluated Sesame Street's "Little Children, Big Challenges: Incarceration" initiative with children aged 3 to 8 years with a jailed father. Seventy-one diverse children and their caregivers were randomized to an educational outreach group (n = 32) or wait list control group (n = 39). Researchers observed children during jail visits and interviewed caregivers by phone 2 and 4 weeks later. The effects of the intervention on children's behavior and emotions occurring during a jail visit depended on what children had been told about the father's incarceration. Children who were told honest, developmentally appropriate explanations showed less negative affect at entry, an increase in negative affect when the intervention was administered, and a decrease in negative affect during the visit. Intervention group children who were told distortions, nothing, or explanations that were not developmentally appropriate showed more negative affect initially, and their negative affect remained relatively stable during their time in the jail. In addition, children who were told the simple, honest truth about the parent's incarceration (a recommendation in the educational materials) exhibited more positive affect during the visit, with a medium effect size. Caregivers in the educational outreach group reported more positive change in how they talked to children about the incarceration over time compared to the control group.

Differences in Sexual Health Outcomes Between Adolescents in Public Schools and Juvenile Correctional Facilities.

Data from a statewide, anonymous survey were used to test for differences between adolescents' sexual health behaviors and their outcomes across settings. Youth in juvenile correctional facilities (JCFs) were disproportionally male and Black compared to their peers in public schools. Youth in JCFs were significantly more likely than their peers to report that they had ever had sex, used substances prior to last sex, or been involved in a pregnancy. They were less likely to have used condoms or contraception at last sex, or to report having talked with their partners about sexually transmitted infections or birth control. The results highlight the importance of comprehensive sexual health education and access to a reproductive health provider for students in JCFs.

Fathers in Jail and their Minor Children: Paternal Characteristics and Associations with Father-Child Contact.

OBJECTIVES: More than five million children have experienced a co-resident parent leaving to spend time behind bars. Most incarceration occurs in jails, yet little is known about contact between parents in jail and their minor children. Such information is essential to inform programming and policy to support families in the context of incarceration. METHODS: In the present study, 315 fathers in jail with minor children (3-17 years old) were recruited from four jails in the Midwest region of the United States. Fathers in jail reported their demographic information, incarceration-related characteristics (e.g., number of prior arrests), children's exposure to incarceration-related events, and frequency of contact with their children. RESULTS: Four main findings emerged: 1) telephone contact was the most common modality for engaging with children during a paternal jail stay, with 22% of fathers reporting daily phone contact with children, 2) types of contact were correlated, so that more phone contact and letter writing were associated with more frequent visits, 3) White, non-Hispanic fathers and those who did not plan to live with their children upon release were less likely to report telephone contact with their children, and 4) children who witnessed their fathers' arrest were less likely to write and children who witnessed their fathers' criminal activity were less likely to visit. CONCLUSIONS: Contact between fathers in jail and children has implications for the parent-child relationship. Future research should explore quality of and barriers to contact, including incarceration-related events.

Association of Social and Community Factors with U.S. Breastfeeding Outcomes.

Objective: To explore, in a large, nationally representative U.S. sample of children, potential independent associations between social and community factors and breastfeeding outcomes, using the Social Ecological Model as a theoretical framework. Materials and Methods: A secondary data analysis of the 2011-2012 National Survey of Children's Health was conducted (N = 29,829). Multivariate logistic regression was performed to estimate associations between predictor variables (parental emotional support, neighborhood social support, neighborhood safety, neighborhood amenities, and medical home) and breastfeeding outcomes (breastfeeding initiation [BFI] and exclusive breastfeeding for 6 months [EBF6m]). For predictor variables reaching statistical significance in the adjusted models, we performed subgroup analyses by race-ethnicity. Results: After adjusting for individual- and family-level sociodemographic and maternal-child health factors, living in a neighborhood with 4 amenities was associated with 1.54 (95% confidence interval [CI] 1.06-2.23) times the odds of BFI, compared to children living in neighborhoods with no amenities. There was a negative association (adjusted odds ratio [aOR] 0.83; 95% CI 0.70-0.99) between neighborhood social support and BFI, although living in a supportive neighborhood was associated with 1.37 (95% CI 1.11-1.69) times the odds of EBF6m. There was a negative association (aOR 0.71; 95% CI 0.54-0.93) between perceived neighborhood safety and EBF6m. The observed associations differed by race-ethnicity. Conclusion: Community-level structural and social support factors influence breastfeeding outcomes, independent of previously described individual level sociodemographic factors, and the observed associations differ by race-ethnicity. These findings have implications for the development of "breastfeeding-friendly" communities and public policies.

Parental incarceration and youth tobacco product use: Implications for prevention and the e-cigarette epidemic.

PURPOSE: Youth smokers have high rates of adverse childhood experiences, and particularly parental incarceration (PI). In Minnesota, 16% of youth have experienced PI, but 55% of daily smokers report PI. However, no research has examined how PI relates to a range of tobacco products, which is critical considering the current e-cigarette epidemic. There is also limited research on protective factors for tobacco use among youth with PI. METHODS: Data came from 2016 Minnesota Student Survey (N = 111,091); 85% of Minnesota schools participated. We assessed 30-day use of cigarettes, non-cigarette combustible products, smokeless products, e-cigarettes, and dual/poly use. Using descriptive statistics and logistic regressions, we compared use across current, previous, and no PI experience. We also tested how protective factors related to tobacco use. RESULTS: Youth with current PI experience used all products with higher frequency compared to youth with previous and no PI experience. Use prevalence among youth with current PI were 26.0% (95% CI = 24.1, 27.8) for e-cigarettes, 20.8% (95% CI = 19.1, 22.5) for dual/poly use, 17.8% (95% CI = 16.2, 19.5) for cigarettes, 17.4% (95% CI = 15.8, 19.0) for combustible non-cigarettes, and 9.9% (95% CI = 8.6, 11.2) for smokeless products. Nearly all protective factors were significantly and negatively related to use of all products, regardless of PI experience. CONCLUSIONS: Youth with PI experience are at high risk for using multiple tobacco products. These disparities were most pronounced for e-cigarettes, demonstrating the e-cigarette epidemic is disproportionately occurring among youth with current and previous PI experience. All examined protective factors buffer risks for this population of youth.

Are We Meeting Their Needs? Well-child, Dental, and Mental Health Care for Youth in Juvenile Correctional Facilities in Minnesota.

Compared with the general population, justice-involved youth have substantially higher rates of several health conditions. Less is known about their use of health services to address these conditions. Using data from a statewide survey of 217 youth in juvenile correctional facilities and 164,832 youth in public schools, we examined selfreported health (health overall, weight status, disability, asthma, allergy, mental health) and receipt of care. Justice-involved youth reported a high number of physical health concerns; however, physical health conditions were not related to receipt of care. Youth who reported experiencing depressive symptoms with or without suicidal ideation, and those who had attempted suicide, were more likely than their peers without these mental health issues to have received mental health treatment in the past year. However, many youth with serious mental health concerns had not received treatment. Results from this study demonstrate unmet health care needs among a sample of youth in juvenile correctional facilities.

Externalizing Behavior Among Youth With a Current or Formerly Incarcerated Parent.

This study examined associations between parental incarceration and youths' externalizing behaviors (e.g., damage to property, fighting, theft, etc.). Data were drawn from the 2016 Minnesota Student Survey, a statewide sample of 126,868 youth in public schools. Logistic regression analyses examined associations between youths' experience of parental incarceration and their self-reported externalizing behaviors, controlling for key demographic characteristics. Youth with a currently or formerly incarcerated parent reported significantly more externalizing behaviors compared with youth who never had a parent incarcerated. In addition, youth with a currently incarcerated parent reported significantly more externalizing behaviors than youth who had a formerly incarcerated parent in six out of the eight externalizing behaviors. However, youth who reported having a formerly incarcerated parent were more likely to report lying or conning and more likely to have difficulty paying attention than youth who currently had an incarcerated parent. Results illustrate that parental incarceration has important implications for youths' own risk for delinquency and high-risk behavior.

Substance Use Outcomes for Hispanic Emerging Adults Exposed to Incarceration of a Household Member during Childhood.

This study investigates whether Hispanic emerging adults exposed to household incarceration before age 18 report higher rates of past 30-day cigarette, alcohol, binge drinking, marijuana use, and negative substance use consequences, relative to participants not exposed to incarceration of a household member. Respondents were matched on key characteristics to create balanced groups of exposed and nonexposed respondents. Negative binomial regression models assessed primary research questions. There were significant long-term associations between household incarceration and the frequency of past 30-day binge drinking, marijuana use, and number of negative substance use consequences. Policies and health programs addressing household incarceration may be a promising prevention approach to reduce negative substance use outcomes among Hispanic emerging adults.

Adverse Childhood Experiences and Youth Cigarette Use in 2013 and 2016: Emerging Disparities in the Context of Declining Smoking Rates.

INTRODUCTION: Cigarette use has dropped dramatically among youth since 2013, but smoking-related disparities persist. We examine who still smokes in the context of declining smoking rates. Using the Minnesota Student Survey, we examine adverse childhood experiences (ACEs) and cigarette use in 2013 and 2016. We assess how cigarette use rates changed, how ACEs relate to cigarette use, and the degree to which youth with ACEs comprise the current smoking population. METHODS: Data came from the 2013 and 2016 Minnesota Student Survey. We assessed past 30-day any and daily cigarette use statewide and among youth with no ACEs, high cumulative ACEs, and seven separate ACEs. We used descriptive statistics and multivariate logistic regression analyses. RESULTS: Cigarette use significantly declined for all groups from 2013 to 2016. Youth with no ACEs exhibited the highest percent decrease in any and daily cigarette use. Youth with ACEs were more likely to report any and daily cigarette use in 2013 and 2016, adjusting for demographics. Among youth with any 30-day use, the rate of ACEs increased from 2013 to 2016. Youth with ACEs disproportionately accounted for youth smoking populations in 2013 and 2016. For example, although 16% of all youth experienced parental incarceration, approximately 43% and 55% of youth with any and daily cigarette use experienced parental incarceration in 2016, respectively. CONCLUSIONS: Cigarette use declined from 2013 to 2016 for all Minnesota youth, but the decline among youth with no ACEs was faster than those with ACEs. Youth with ACEs now account for an increasingly high percent of youth smokers. IMPLICATIONS: Even though cigarette use is declining among Minnesota youth, the decline among youth without ACEs is faster than the decline among youth with ACEs. Youth with ACEs disproportionately account for all youth smokers, and this disproportionality has increased since 2013. Tobacco control efforts should focus on youth with ACEs, and parental incarceration is a specific ACE that warrants attention. Rates of parental incarceration remain high in the United States and youth who experience parental incarceration now account for a near majority of current youth smokers. Future research should consider mechanisms for the ACE-smoking relationship and emerging tobacco products (eg, electronic cigarettes).

The Role of Familial Incarceration and Ethnic Identity in Suicidal Ideation and Suicide Attempt: Findings from a Longitudinal Study of Latinx Young Adults in California.

Suicide is a leading cause of death among young adults; however, contextual risks and cultural factors are rarely studied in the context of ethnic minority suicidal ideation (SI) and suicidal attempt (SA). This study assessed the association between familial incarceration and suicide behaviors and examined ethnic identity as a potential moderator. Data from a longitudinal study of health among Hispanics (n = 1,094) in California were used to test associations between familial incarceration, ethnic identity, and SA and SI, adjusting for demographic factors and covariates. Approximately 18% and 8% of respondents reported SI and SA, respectively. Compared to no incarceration, or the incarceration of a relative, parental incarceration was associated with higher odds (AOR: 2.09, 95% CI: 1.23-3.34) of SI whereas higher affective ethnic identity reduced the odds (AOR: 0.52, 95% CI: 0.31-0.89) of SA. Ethnic identity moderated the association between parental incarceration and SI (AOR: 0.33, 95% CI: 0.13-0.79). Incarceration of a family member can set the stage for exclusion from critical institutions and can have long-term consequences for adult mental health. Promoting a positive ethnic identity may be a promising prevention strategy that could bolster resilience among at-risk, urban minority youth.

Adverse Childhood Experiences and Weight Status among Adolescents.

OBJECTIVE: To investigate the relationship between adverse childhood experiences (ACEs) and weight status among adolescents. STUDY DESIGN: Data were drawn from the Minnesota Student Survey, a large (n = 105 759), statewide, anonymous survey of public school students in eighth, ninth, and eleventh grades. Self-reported height and weight were used to calculate body mass index. Multinomial logistic regression was used to examine associations between self-reported ACEs and weight status, controlling for key sociodemographic characteristics. RESULTS: ACEs were positively associated with weight status; adolescents with more ACEs were more likely to have overweight, obesity, and severe obesity than adolescents with no ACEs. Adolescents who reported an ACE were 1.2, 1.4, and 1.5 times as likely to have overweight, obesity, and severe obesity, respectively, compared with their peers with no ACEs. There was no relationship between ACEs and underweight. CONCLUSIONS: The results of this large sample of adolescents with anonymous data support the hypothesis that ACEs and obesity are strongly associated. The directionality of this relationship needs to be understood. Moreover, these findings suggest that child health professionals may need to screen for ACEs as an important aspect of clinical weight management.

Intention and Initiation of Breastfeeding Among Women Who Are Incarcerated.

The Baby-Friendly Hospital Initiative recommends that all mothers be shown how to breastfeed, even when mothers and newborns are separated. Most incarcerated women are separated from their infants after the postpartum hospital stay, creating barriers to breastfeeding. We examined breastfeeding among a sample of women participating in a prison-based pregnancy program. Quantitative data indicated that women who discussed breastfeeding with their doulas were more likely to initiate breastfeeding. Three qualitative themes were identified: Benefits of Breastfeeding, Barriers to Breastfeeding, and Role of the Doula. We identified incongruence between the expected standard of breastfeeding support and the care incarcerated women received. Findings suggest that prison-based doula care might be an effective intervention for supporting breastfeeding among incarcerated women and highlight the importance of education for perinatal nurses about breastfeeding support of incarcerated women.

For Whom Do Parenting Interventions to Prevent Adolescent Substance Use Work?

Adolescent substance use continues to be a significant public health problem. Parent training interventions are effective preventive strategies to reduce youth substance use. However, little is known about differences in effectiveness for youth across demographic characteristics. This review assessed the effectiveness of parent training programs at reducing adolescent substance use by participant gender, age, and race/ethnicity. Pubmed/MEDLINE, ERIC, CINAHL, and PsycINFO were searched from database origin to October 31, 2016. We included randomized controlled trials that evaluated parent training interventions; reported youth initiation or use of tobacco, alcohol, or other illicit substances; and included adolescents aged 10 to 19. Two independent reviewers extracted data. Disagreements were resolved by consensus or a third researcher. Data were synthesized using harvest plots stratified by participant demographics. A total of 1806 publications were identified and reviewed; 38 unique studies were included. Risk of bias of included studies was high. No studies targeted male teens or youth in late adolescence. Few studies targeted Asian-American, Black/African-American, or Hispanic/Latino adolescents. Overall, interventions including male and female youth and youth in early adolescence (age 10 to 14 or in 5th to 8th grade) were more beneficial than interventions including female-only or both young and older adolescents. Programs tailored to specific racial/ethnic groups, as well as programs designed for youth from multiple races/ethnic groups, were effective. Current evidence supports the benefits of offering parenting guidance to all families with adolescent children, regardless of the gender, age, or race/ethnicity of the adolescent.

Substance Use among Youth with Currently and Formerly Incarcerated Parents.

Parental incarceration impacts millions of children in the U.S. and has important consequences for youths' adjustment. Children of incarcerated parents are at risk for a host of negative psychosocial outcomes, including substance abuse problems. Using data from a statewide survey of youth behavior, the effect of both present and past parental incarceration on youths' report of their substance use behaviors was examined. Both present and past parental incarceration was significantly associated with use of alcohol, tobacco, marijuana, and prescription drugs, as well as substance abuse and dependence. Implications for practice and research are discussed.

School-Based Outcomes Among Youth With Incarcerated Parents: Differences by School Setting.

BACKGROUND: Parental incarceration impacts millions of children in the United States and has important consequences for youths' adjustment and school-based outcomes. METHODS: Using data from a survey of youth behavior in one large Midwestern state, we examined the effect of both present and past parental incarceration on school-based outcomes, across 3 school settings (public schools, alternative learning centers, and juvenile correctional facilities). RESULTS: Parental incarceration was significantly associated with students' poor school-based outcomes; however, these effects varied markedly by school setting. Among youth in public schools, parental incarceration was consistently associated with poor school outcomes. There were mixed effects among youth in alternative learning centers and no significant effects among youth in juvenile correctional facilities. CONCLUSIONS: The study adds to a body of literature demonstrating the negative effects of parental incarceration on youth's school-based outcomes for youth in public schools; however, findings were mixed for youth in alternative learning centers and juvenile correctional facilities. Implications for future research and school practitioners are discussed.