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.

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.

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.

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.

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.

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.

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.

Maternal resources and household food security: evidence from Nicaragua.

OBJECTIVE: Women (especially mothers) are theorized as critical to reducing household food insecurity through their work and caregiver roles. The present study tests these assumptions, assessing how maternal economic and social resources are associated with food insecurity in households with young children. DESIGN: Data from a population-based sample of households was collected in León, Nicaragua (n 443). Data include a newly validated measure of household food insecurity (ELCSA), maternal resource measures, and household economic status and demographics. Regression analysis tests the statistical associations (P<0·05) of maternal resources with household, adult-specific and child-specific food insecurity. SETTING: Municipality of León, Nicaragua. SUBJECTS: Households with children aged 3-11 years in rural and urban León. RESULTS: Only 25% of households with young children were food secure, with 50% mildly food insecure and 25% moderately/severely food insecure. When mothers contributed substantially to household income, the odds of moderate/severe household food insecurity were 34% lower than when their spouse/partner was the main provider. The odds of food insecurity were 60% lower when mothers managed household money, 48% lower when mothers had a secondary (v. primary) education, 65% higher among single mothers and 16% lower with each indicator of social support. Results were similar for adult- and child-specific food insecurity. CONCLUSIONS: This research provides new evidence that maternal economic and social resources are important for reducing household food insecurity and adult- and child-specific food insecurity. Women's social status, social support and access to economic resources need to be enhanced as a part of policies aimed to reduce food insecurity in high-poverty settings.

Intra-population variation in anemia status and its relationship to economic status and self-perceived health in the Mexican Family Life Survey: implications for bioarchaeology.

Recently scholars have advocated for the use of a critical biocultural approach in bioarchaeology, where osteological and dental markers of stress are used to understand the broader biosocial context of past populations. However, the ability to accomplish this task rests on the assumption that ultimate-level environmental stressors and well-being in the past can be reconstructed from the prevalence of pathologies in skeletal collections. Here we test this assumption using anemia prevalence in the Mexican Family Life Survey. Specifically we test three hypotheses: (1) that individuals sharing the same household are more likely to share anemia status; (2) anemia status is a predictor of economic status (a common proxy for broader environmental context); and (3) anemia status is related to self-rated health. Results demonstrate that: anemia status was not commonly shared between household members; there was a significant overlap in economic status between anemic and nonanemic individuals (i.e., anemia poorly predicted economic status) and; while anemia status was associated with self-perceived health, the majority of those who reported poor health were nonanemic while a significant number of those who reported very good health were anemic. We argue that these findings are likely related to variation in individual frailty, which is shaped by biological and cultural risk factors. Therefore, we advocate for greater incorporation of individual frailty into bioarchaeological investigations, and, in effort to overcome some of the difficulties associated with this task, increased use of data from living populations and greater collaboration between bioarchaeologists and human biologists.

Assessing the well-being of partners of people found guilty of perpetrating genocide in Rwanda.

This article draws upon 89 in-person surveys with Rwandan women (ages 26-75) whose partners were incarcerated for genocide and examines how these women explain participation in the violence. We first engage in exploratory factor analysis of reasons cited for perpetrating genocide, which reveals (1) a factor comprised of internal reasons for participation, including greed and hatred; (2) a factor of external reasons, such as peer pressure or coercion, and (3) a factor driven by alcohol use. Next, we analyze how these factors are associated with the women's psychosocial wellbeing as measured by the World Health Organization's Self-Reporting Questionnaire. This quantitative analysis finds that, net of relevant control variables, accounts of participation in genocide that emphasize external reasons for participation are associated with better psychosocial wellbeing, while accounts of participation that emphasize internal reasons are associated with worse psychosocial wellbeing. We conclude by addressing the link between explanations for actions and wellbeing.

Family structure and obesity in early childhood.

This study informs family and child health research by using longitudinal Fragile Families data to assess how family structure and transitions are associated with changes in children's BMI and weight status between ages three and five. Concerns in family structure literature about biases due to selectivity are reduced through the use of change score models and by controlling for parental BMI. The findings indicate unhealthy BMI gain and an increased risk of becoming overweight/obese among children living with a mother who recently dissolved a union or had been living without a partner for at least 2years compared with those in stable married parent families. Children with single mothers who entered a new union had significantly healthier BMI trajectories than those whose mothers remained single or recently became single. These results suggest the importance of two-parent family contexts for children's healthy physical development, and that single mothers may need additional support to better manage their children's BMI.

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.

Union Type and Depressive Symptoms Among Mexican Adults.

Diversity in union type is increasing around the world as cohabitation and higher order unions become more prevalent in developing and developed countries. This necessitates a more nuanced understanding of how different union types relate to individual well-being across social settings. In this study, the authors analyze nationally-representative data from Mexico in cross-sectional and change models to evaluate differences in depressive symptoms across union type (marital vs. cohabiting and first vs. higher order unions) among Mexican men and women. The findings suggest that cohabiting unions do not provide the same mental health benefits as marital unions (especially for men). Repartnering is also associated with higher depressive symptoms (especially for women), which indicates possible lasting mental health disadvantages of divorce/separation or entrance into lower quality second unions. These results suggest that the changing family context in Mexico, which includes increasing cohabitation and union instability, may have important consequences for individuals' psychological well-being.

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.

Household income during childhood and young adult weight status: evidence from a nutrition transition setting.

This article explores whether household income at different stages of childhood is associated with weight status in early adulthood in a nutrition transition setting (a developing country with both underweight and overweight populations). I use multinomial logistic regression to analyze prospective, longitudinal data from Cebu, Philippines. Results suggest that increasing prenatal income is associated with lower risk of being underweight at age 21, while increasing income during childhood is associated with an increased risk of being overweight at age 21. When gender differences are considered, prenatal income has an important protective effect against the risk of being overweight for girls. For boys, prenatal income has little effect on overweight status, but early childhood income increases their risk of becoming overweight. For both boys and girls, income in mid-childhood (ages 9-12) is associated with a particularly high risk of becoming overweight by age 21, net of earlier income. These results suggest that, in this nutrition transition setting, childhood income operates through complex developmental and behavioral mechanisms to affect early adult overweight status; and that increasing household income after birth may do little to prevent underweight status in early adulthood.

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.

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.