Exposure to Armed Conflict and HIV Risk Among Rwandan Women.

This article focuses on the link between past exposure to violence and a critical public health issue in sub-Saharan Africa: HIV-positive status in women of reproductive age. Specifically, we use biosocial data from the Rwandan Demographic and Health Survey (2005‒2014) to assess how the timing and intensity of women's exposure to the war and genocide in Rwanda (1990‒1994) may be associated with their HIV status. We find significant differences in risk across age cohorts, with the late adolescence cohort (women born in 1970‒1974, who were aged 16‒20 at the start of the conflict) having the highest risk of being HIV positive 10‒20 years after the violence, even after controlling for current socioeconomic and demographic characteristics. Women who reported two or more sibling deaths, excluding those related to maternal mortality, during the conflict years also had higher odds of being HIV positive, net of cohort and control variables. Age at first sexual intercourse and number of lifetime sexual partners partially-but not fully-explain the associations between cohort and sibling deaths and HIV. These findings advance research related to armed conflict and population health and indicate that experiencing conflict during key stages of the life course and at higher intensity may affect women's long-term sexual health.

Family Disruption and Parenting During the COVID-19 Pandemic.

Using unique data from an economically and racially diverse sample of 448 caregivers with young children (ages 4-9 years) in Ohio, we assess multiple sources of family social and economic disruptions and their associations with parenting activities during the COVID-19 stay-at-home order. Caregivers reported extensive social and economic challenges during this time, while also increasing (on average) their time spent in play/learning activities. Time spent in discipline was less likely to increase during this period. We found significant associations among disadvantaged social conditions/experiences and parenting, and that some effects were moderated by 2019 household income status. Unexpectedly, changes in economic conditions, particularly caregiver job loss, were associated with higher odds of increases in reading/telling stories time across household income groups. Overall, findings indicate that social conditions associated with the stay-at-home period of COVID-19 might have been more disruptive to parenting for caregivers with young children than the short-term economic changes.

Early childhood stress responses to psychosocial stressors: The state of the science.

The aim of this systematic review was to better understand whether and to what extent psychosocial stressors are associated with hypothalamic-pituitary-adrenal axis or autonomic nervous system stress responses in young children (1-6 years of age). Studies were classified by psychosocial stressors from the ecobiodevelopmental model: social and economic resources, maternal mental health, parent-child relationships, and the physical environment. Of the 2388 identified studies, 32 met full inclusion criteria, including over 9107 children. Child physiologic stress responses were measured as hair and urinary cortisol and cortisone, salivary diurnal and reactive cortisol, salivary reactive alpha-amylase, and respiratory sinus arrhythmia. There were 107 identified relations between psychosocial stressors and physiologic stress responses. Nearly two thirds of these relations suggested that children have dysregulated stress responses as either significantly blunted (n = 27) or increased (n = 37); 43 relations were not significant. Children most consistently had significantly dysregulated stress responses if they experienced postnatal maternal depression or anxiety. Some reasons for the mixed findings may be related to characteristics of the child (i.e., moderators) or stressor, how the stress response or psychosocial stressor was measured, unmeasured variables (e.g., caregiving buffering), researcher degrees of freedom, or publication bias.

Parent Time Investments in their Children's Learning during a Policy-Mandated Shutdown: Parent, Child, and Household Influences.

State-level policies in Ohio during the early months of the COVID-19 pandemic in the U.S. involved physical school closures and work-from-home requirements when possible. Presumably, these policies and resulting impacts on homes with children would alter parent time investments in their children with respect to home-learning activities. In this study, we assessed parent time investments specific to home-learning activities with their children, and key predictors of these investments. Using data from a comprehensive survey completed by 559 caregivers of children (aged birth to 9 years) during a state-mandated stay-at-home order and widespread school closure, we assessed whether parent time investments in children's learning were associated with: (1) parents' mental health and social connectedness, (2) children's level of emotional distress, and (3) household characteristics including chaos, social needs, and structure. Results indicate significant negative associations between each of parent loneliness, children's emotional distress, and household chaos with parent time investments in children's learning, controlling for parents' socio-demographic and economic status. This suggests that parent time investments during the early stages of the pandemic were limited by a number of factors outside of socioeconomic resources. Further research is needed to understand the long-term effects of home environments, including parent time investments in children's learning, on child development during this unprecedented time in world history.

Understanding family life during the COVID-19 shutdown.

Objective: Our study investigates how changes in family contexts were associated with child behaviors during Ohio's COVID-19 shutdown of early 2020. Background: The COVID-19 pandemic caused major economic and social changes for families. Rapid research was conducted to assess these changes and their potential impacts on child behaviors. Method: Using a diverse sample of families with children aged birth to 9 years (N = 559), we describe key economic changes and parent-reported stressors experienced during Ohio's shutdown period. Then, we use regression models to examine how these family conditions were associated with child emotional distress and changes in sleep routines. Results: When parents experienced more total COVID-19 pandemic-related stressors, they also reported that their children exhibited more anxious and withdrawn, fearful, acting out, and COVID-19 pandemic-related behaviors (p < 0.01). Conclusion: Families and children living at home in Ohio experienced significant stress during the shutdown. These findings can be used to inform future studies of the social and economic consequences of the COVID-19 pandemic for parents and children. Implications: Families and children have experienced multiple stressors during the COVID-19 pandemic. Researchers and practitioners should continue to monitor and support families and children to mitigate potential lasting consequences.

Racial and Economic Adversity Differences in Stress Markers and Immune Function Among Urban Adolescents.

BACKGROUND: Exposure to racism and associated adversities, such as poverty, is hypothesized to contribute to racial inequities in health via stress and immune pathways. Furthermore, the effects of adversity may be more salient during sensitive developmental periods. Our study examined racial differences in stress and immune biomarkers during adolescence and the effects of exposure to economic adversity at distinct developmental time periods and cumulatively in accounting for potential racial differences. METHODS: Secondary analysis of the Adolescent Health and Development in Context study was conducted. Data were derived from self-administered surveys; interviews; smartphone-based, geographic-explicit ecological momentary assessment; stress biomarkers (evening salivary cortisol over six nights and hair cortisol); and immune biomarkers (salivary shedding of Epstein-Barr virus [EBV] DNA among EBV-positive adolescents). Current socioeconomic status measures included annual household income and caregiver education. Caregivers also reported experiences of bankruptcy, difficulty paying bills, receipt of food stamps/Supplemental Nutrition Assistance Program/electronic benefit transfer, and job loss when the child was of ages birth-5 years, 6-10 years, and 11 years or older. An affirmative response to any item was defined as exposure to economic adversity for that developmental time period (yes/no). A cumulative economic adversity measure was calculated as the sum of exposures across developmental periods (0 = never exposed to 3 = exposed across all time periods). Descriptive and multivariable regression analyses were conducted, accounting for covariates. RESULTS: Black/African American adolescents had higher salivary cortisol concentration, higher hair cortisol concentration, and an increased odd of salivary shedding of EBV DNA compared to White adolescents. Racial differences were not attenuated by the current socioeconomic status or economic adversity (developmental period or cumulatively). DISCUSSION: Our study provides evidence that stress and immune biomarkers differ by race as early as adolescence and may be one pathway through which racism and associated adversities contribute to racial health inequities. Further research on the contribution of multiple adversities beyond poverty to racial inequities in physiological stress and health is critical for informing effective prevention and intervention efforts.

Exposure to police-related deaths and physiological stress among urban black youth.

BACKGROUND: Emerging evidence indicates that exposure to police-related deaths is associated with negative health and wellbeing outcomes among black people. Yet, no study to date has directly examined the biological consequences of exposure to police-related deaths for urban black youth. METHODS AND FINDINGS: We employ unique data from the 2014-16 Adolescent Health and Development in Context (AHDC) study - a representative sample of youth ages 11 to 17 residing in the Columbus, OH area. A subsample of participants contributed nightly saliva samples for cortisol for up to six days, providing an opportunity to link recent exposures to police-related deaths within the residential county to physiological stress outcomes during the study period (N = 585). We examine the effect of exposure to a recent police-related death in the same county on the physiological stress (nightly cortisol) levels of black youth. We find evidence of elevated average levels of nightly cortisol (by 46%) for black boys exposed to a police-related death of a black victim in the 30 days prior to the subject's cortisol collection. We find no evidence of police-related death effects on the physiological stress levels of black girls or white youth. CONCLUSIONS: These analyses indicate that police-related deaths influence the biological functioning of black boys, with potential negative consequences for health. We consider the implications of exposure to lethal police violence among black boys for understanding racial disparities in health more broadly.

Tranquility is a child with a full belly: Pathways linking food insecurity and maternal mental distress in Nicaragua.

A growing body of literature identifies food insecurity (FI) as a critical social determinant of mental health. Across settings, quantitative studies report positive correlations between FI and mental distress, especially among women. Less understood are the pathways by which FI undermines women's mental well-being. To address this gap, we conducted six focus group discussions with 45 Nicaraguan mothers. Thematic analysis identified three themes linking the management of FI and maternal mental well-being in this setting. The theme, la lucha, underscored how the chronicity of FI served as a constant mental strain by demanding mothers strategize on a daily basis to resolve it. The themes "tranquility is a child with a full belly" and "the despairing and frustrated mother" emphasized how FI challenged women's abilities to fulfill the responsibilities of motherhood and served as a reminder of social status. Our findings advance earlier quantitative work by identifying how the management of food insecurity undermines maternal mental well-being in a low-middle income setting and indicate that policies aimed at combating food insecurity can concomitantly improve maternal mental well-being if they bolster women's agency and work to reduce the stigma associated with being food insecure.

Maternal postpartum stress and toddler developmental delays: Results from a multisite study of racially diverse families.

Maternal psychosocial stress during pregnancy can adversely influence child development, but few studies have investigated psychosocial stress during the postpartum period and its association with risk of toddler developmental delays. Moreover, given the expanding diversity of the U.S. population, and well-documented health and stress disparities for racial and ethnic minorities, research examining the effect of postpartum stress on risk of developmental delays in diverse populations is of critical importance. In this study, data from the Community Child Health Network provided the opportunity to test maternal postpartum stress as a predictor of toddler risk of developmental delay in a sample of African American, Latina and non-Hispanic White women and their toddlers (N = 1537) recruited in urban, suburban, and rural communities. Postpartum maternal stress over 1 year was operationalized as perceived stress, life events, and negative impact of life events. Regression results revealed higher risk of developmental delays in toddlers whose mothers experienced more negative life events, greater negative impact of events, and higher perceived stress over the year. Prenatal stress, pregnancy/birth complications, and postpartum depression did not explain these associations. Maternal postpartum stress may contribute to increased risk for developmental delays and is an important target for psychosocial intervention.

Inflammation among Children: Evidence of an Immigrant Advantage?

Past research on the immigrant health paradox suggests that children with immigrant parents may have a health advantage over those with U.S.-born parents, especially if the parent is a recent immigrant. Other research emphasizes the social and economic challenges children with immigrant parents face, in part due to disadvantaged social class and racial/ethnic positions. Underlying physiological changes due to chronic stress exposures among children in immigrant families is one potential health disadvantage that may not yet be apparent in traditional health measures. To explore these biological disparities during childhood, I use national biomarker and survey data from NHANES (N=11,866) to evaluate parent nativity and educational status associations with low-grade inflammation, indicated by C-reactive Protein (CRP), in children ages 2-15 years. I find that children with an immigrant parent, and particularly a low-education immigrant parent, have higher CRP, net of birth, BMI and other factors, than children with a U.S. born parent with either a low or higher education. Comparing children with low-educated parents, those with a foreign-born parent have higher predicted CRP. The findings from this study provide new evidence that children living in immigrant families in the U.S. may be facing higher levels of chronic stress exposure, as indicated by the increased risk of low-grade inflammation, than those with U.S.-born parents. The physiological changes related to increased risk of inflammation could set children in immigrant families on pathways towards mental and physical health problems throughout childhood and later in the life course.

Conditions of Poverty, Parent-Child Interactions, and Toddlers' Early Language Skills in Low-Income Families.

Objectives The study examined the relations between parent-child interaction in the first year of life to toddlers' language skills at age 2 years for a sample of children reared in poverty; of specific interest was testing the Family Stress Model, which proposes that the conditions of poverty influence children's language skills through caregiver well-being (e.g., distress, depression) and interaction dysregulation. Methods Participants were from the Kids in Columbus Study, a birth-cohort study of children born to urban families experiencing material hardship. Caregiver questionnaires were collected when the child was 4-7 months to document poverty conditions (maternal hardship, institutional resources), caregiver well-being (depression, distress), and dysregulation in parent-child interactions. The Bayley-III assessed receptive and expressive language skills when the children were 2 years. Results On average, receptive language skills were nearly 1 SD below the normative mean. Path models showed a significant effect of caregiver-child dysregulated interactions on toddlers' language skills, and an indirect effect of maternal distress on parent-child interactions and, in turn, toddlers' language skills. Conclusions for Practice This study confirmed the theoretical Family Stress Model as a viable representation of the effects of poverty on the language skills of toddlers reared in homes experiencing socioeconomic disadvantage.

Early childhood family instability and immune system dysregulation in adolescence.

Exposure to stress is one way in which social disadvantages during childhood may alter biological and psychological systems with long-term consequences. Family social and economic conditions are critical for early childhood development and exposure to difficult family conditions may have lasting physiological effects. However, there is little research linking early childhood conditions with physiological indicators of stress and system dysregulation in adolescence. In this study, we assess how family social and economic instability that occurred in early childhood (birth to age 5) is associated with immune system dysregulation in adolescence, as indicated by DNA shedding of the Epstein-Barr virus (EBV). We utilize a biomarker of EBV obtained through saliva, a non-invasive method of collecting immune-system biomarkers, in 674 adolescents 11-17 years old. Multivariable regression results indicated that experiences of moving into a new parent/caregiver household or moving in with a grandparent during early childhood was associated with an estimated 100% increase in EBV DNA shedding among prior EBV-infected adolescents. Other measures of early childhood family instability, total number of family structure changes and economic insecurity, were marginally significant. Contemporaneous family conditions were not associated with adolescents' EBV DNA shedding.

Family contexts and sleep during adolescence.

Sleep deprivation among adolescents has received much attention from health researchers and policymakers. Recent research indicates that variation in sleep duration from night to night is associated with multiple health outcomes. While there is evidence that sleep deprivation is socially patterned, we know little about how social contexts are associated with nightly sleep variation during adolescence (a life course stage when nightly sleep variation is particularly high). Given the importance of family environments for influencing adolescents' sleep patterns, we hypothesized that disadvantaged family contexts would be associated with higher intra-individual variation (IIV) in nightly sleep duration, in addition to lower average nightly sleep duration. We tested these hypotheses in a diverse, population-based sample of 11-17 year-olds (N = 1095) from the Adolescent Health and Development in Context Study. Using survey and ecological momentary assessment data and a novel form of multi-level regression modeling (location-scale mixed modeling), we found that adolescents living in unmarried-parent, low SES, economically insecure, and high caregiver stress families had higher IIV in sleep than adolescents in families with more resources and less caregiver stress. There were fewer family effects on average sleep duration. This suggests family social and economic contexts are associated with an under-researched aspect of adolescent sleep, nightly variation, and may contribute to adolescent sleep problems with implications for their health and health disparities.

Racial-ethnic Disparities in Inflammation: Evidence of Weathering in Childhood?

Building on the weathering hypothesis, we advance health disparities research by assessing racial-ethnic differences in low-grade inflammation, a marker of chronic stress exposure, in young children. Using nationally representative data from the National Health and Nutrition Examination Survey (N = 6,652) and logistic regression, we find an increased risk of low-grade inflammation among Hispanic and African American children compared to white children. The risk of inflammation appears to be stronger for Hispanic and African American children with foreign-born parents compared to children of the same race-ethnicity with U.S.-born parents. Low parental education and elevated child body mass index work as partial mediators of these associations. Our findings suggest the need to understand the psychosocial challenges faced by Hispanic and African American children, particularly, those with foreign-born parents, if we are to make further progress in reducing health disparities.

Multipartner Fertility in Nicaragua: Complex Family Formation in a Low-Income Setting.

CONTEXT: Multipartner fertility (having children with more than one partner) is an important topic in demographic research, but little is known about its incidence and correlates in low-income settings, where rates may be high because of poverty, union instability and early childbearing. METHODS: Data from the 2011-2012 Encuesta Nicaragüense de Demografía y Salud were used to calculate the prevalence of multipartner fertility among 8,320 mothers and 2,141 fathers with two or more children. Logistic and multinomial regression were used to identify individual and family characteristics associated with multipartner fertility. RESULTS: Among those with multiple children, 33% of mothers and 41% of fathers had had children with more than one partner. The prevalence of multipartner fertility was elevated among less-educated women, nonreligious men, and women and men who had grown up in urban areas (odds ratios, 1.3-1.6). Multipartner fertility was associated with lower current household wealth among mothers, and with increased risk of single parenthood and higher fertility among mothers and fathers. Fathers who had had multiple fertility partners were six times as likely as fathers with one fertility partner to report not providing financial support to, or sharing their surname with, at least one of their biological children. CONCLUSION: Multipartner fertility is a critical demographic and social phenomenon that may contribute to and reflect important gender and family structure inequalities in Nicaragua. Mothers with multipartner fertility may be at especially high risk of raising children without the children's fathers and with low levels of economic support.

Household food insecurity and child health.

Food insecurity, the lack of consistent access to sufficient quality and quantity of food, affects an estimated 800 million people around the world. Although household food insecurity is generally associated with poor child nutrition and health in the USA, we know less about household food insecurity and child health in developing countries. Particularly lacking is research assessing how associations between household food insecurity and children's health outcomes may differ by child age and among children beyond age 5 years in low-income settings. We use data from a population-based sample of households with children ages 3-11 years (N = 431) in León, Nicaragua to consider how household food insecurity is associated with three measures of child health: illness, anaemia and low height-for-age. Our results provide new evidence that even mild household food insecurity is detrimental to children's health; and that child age conditions the associations between household food insecurity and child health. We find that food insecurity is especially harmful to health during early childhood, but continues to have significant associations with health into middle childhood (up to ages 7-8 years). We discuss the potential implications of these results for future child health research and policies in low-income countries. © 2016 John Wiley & Sons Ltd.

Food insecurity and maternal mental health in León, Nicaragua: Potential limitations on the moderating role of social support.

Poor mental health among those living in poverty is a serious global public health concern. Food insecurity (FI) is recognized as an important, yet critically understudied social determinant of mental health. The relationship between FI and mothers' mental health in low- and middle-income countries (LMIC) is especially important to understand considering the high rates of poverty and associated FI in these settings. For these mothers, social support may serve as a buffer in ameliorating the impact of FI on mental distress. However, data required to understand these relationships in LMIC remain sparse. To address this gap we used quantitative and qualitative data and convergence parallel analysis to assess: the association between FI and maternal mental distress; and, whether three forms of social support - mother's general social network support and family support (spouse/partner living in the home, parents/in-laws living in the home) - moderated the association. A survey that included data on FI (ELCSA) and mental distress (SRQ-20) was administered to a population-based sample of mothers in León, Nicaragua (n = 434) in 2012. The survey was complemented by data from 6 focus groups. Regression models identified a strong positive relationship between household-level FI and maternal distress. Evidence of social support moderation was mixed: while maternal social network and spousal/partner support did not moderate this relationship, parental support did. Our ethnographic data revealed three themes that help explain these findings: FI is embarrassing/shameful, close family is the most appropriate source of social support and, fear of gossip and ridicule limit the buffering capacity of the social support network. Our findings contribute to a growing literature demonstrating that FI is an important social determinant of maternal mental distress in LMIC; and that some forms of social support may reduce (but not eliminate) the impact of FI on mental distress.

Home sweet home? Home physical environment and inflammation in children.

The home environment includes important social and physical contexts within which children develop. Poor physical home environments may be a potential source of stress for children through difficult daily experiences. Using a sub-sample from the Los Angeles Family and Neighborhood Survey (N = 425), we consider how the home physical environment affects stress-related immune system dysregulation in children ages 3-18 years. Results indicated that children in poorer quality homes had higher inflammation (measured by C-reactive protein). The associations were particularly strong for younger children. We also found that part of the home physical environment association with CRP worked through increased risk of obesity for children living in low-quality homes. Future research should assess how home physical environments could be improved to reduce stress and improve health outcomes in children.

Socioeconomic status inequalities in low-grade inflammation during childhood.

BACKGROUND: Family socioeconomic status (SES) is an important source of child health disparities in the USA. Chronic stress is one way SES may impact children's physiology with implications for later health inequalities. These processes may work differently across childhood due to differences in exposure and susceptibility to stressors at different ages. We assess associations between family SES and one biomarker of chronic stress exposure-low-grade inflammation detected by elevated C reactive protein (CRP)-and evaluate differences in the associations by child age. METHODS: We used nationally representative data from the National Health and Nutrition Examination Survey and Tobit regression models to estimate SES associations with CRP and the moderating effects of age for children age 2-18 years. Our sample was limited to CRP ≤10 mg/l to focus on low-grade inflammation (N=13 165). RESULTS: Children whose parent had less than a high school degree had 35% higher CRP than those with a college graduate parent; and, poor children had 24% higher CRP than those with high family income, net of controls. When children's body mass index was accounted for, low education and poverty associations were reduced to 19% and 15%, respectively. Child age interactions were negative and significant for both parental education and family income. CONCLUSIONS: This study provides new evidence that SES is associated with low-grade inflammation in children, and that these associations may be particularly strong during early and mid-childhood. Future research should further our understanding of stressors related to low family SES that may lead to immune system dysregulation during childhood.

Educational Attainment and Timing to First Union across Three Generations of Mexican Women.

We use data from Wave 3 of the Mexican Family Life Survey (N = 7276) and discrete-time regression analyses to evaluate changes in the association between educational attainment and timing to first union across three generations of women in Mexico, including a mature cohort (born between 1930 and 1949), a middle cohort (born between 1950 and 1969), and a young cohort (born between 1970 and 1979). Mirroring prior research, we find a curvilinear pattern between educational attainment and timing to first union for women born between 1930 and 1969, such that once we account for the delaying effect of school enrollment, those with the lowest (0-5 years) and highest levels of education (13+ years) are characterized by the earliest transition to a first union. For women born between 1970 and 1979, however, we find that the pattern between education and first union formation has changed. In contrast to their peers born in earlier cohorts, highly educated women in Mexico are now postponing first union formation relative to the least educated. We draw on competing theories of educational attainment and timing to first union to help clarify these patterns in the context of Mexico.