Mechanisms and pathways linking kindergarten behavior problems with mid-life employment earnings for males from low-income neighborhoods.

Childhood behavior problems are associated with reduced labor market participation and lower earnings in adulthood, but little is known about the pathways and mechanisms that explain these associations. Drawing on a 33-year prospective birth cohort of White males from low-income backgrounds (n = 1040), we conducted a path analysis linking participants' teacher-rated behavior problems at age 6 years-that is, inattention, hyperactivity, aggression-opposition, and low prosociality-to employment earnings at age 35-39 years obtained from tax records. We examined three psychosocial mediators at age 11-12 years (academic, behavioral, social) and two mediators at age 25 years (non-high school graduation, criminal convictions). Our findings support the notion that multiple psychosocial pathways-especially low education attainment-link kindergarten behavior problems to lower employment earnings decades later.

Examining the impact of a change in maternity leave policy in Canada on maternal mental health care visits to the physician.

PURPOSE: Maternity leave is a critical employee benefit that allows mothers to recover from the stress of pregnancy and childbirth and bond with their new baby. We aimed to examine the association between the extension of a maternity leave policy and maternal use of mental health services and prescription drugs in a universal public healthcare system. METHODS: This study uses administrative medical records from 18,000 randomly selected women who gave birth three months before and after an extension of the maternity leave policy. More specifically, mothers who gave birth after January 1st 2001, were entitled to 50 weeks of paid maternity leave, while mothers who gave birth before that date were entitled to only 26 weeks of paid maternity leave. Medical records were analyzed over a seven-year period (i.e., from October 1998 to March 2006). We examined the number and costs of mothers' medical visits for mental health care in the five years following delivery, as well as maternal use of prescribed medication for mental health problems. RESULTS: We found that mothers with extended maternity leave had - 0.12 (95%CI=-0.21; -0.02) fewer medical visits than mothers without a more generous maternity leave and that the cost of mental health services was Can$5 less expensive per women. These differences were found specifically during the extended maternity leave period. CONCLUSIONS: The extra time away from work may help mothers to balance new family dynamics which may result in less demand on the healthcare system.

When the messenger is more important than the message: an experimental study of evidence use in francophone Africa.

BACKGROUND: Epistemic injustices are increasingly decried in global health. This study aims to investigate whether the source of knowledge influences the perception of that knowledge and the willingness to use it in francophone African health policy-making context. METHODS: The study followed a randomized experimental design in which participants were randomly assigned to one of seven policy briefs that were designed with the same scientific content but with different organizations presented as authors. Each organization was representative of financial, scientific or moral authority. For each type of authority, two organizations were proposed: one North American or European, and the other African. RESULTS: The initial models showed that there was no significant association between the type of authority or the location of the authoring organization and the two outcomes (perceived quality and reported instrumental use). Stratified analyses highlighted that policy briefs signed by the African donor organization (financial authority) were perceived to be of higher quality than policy briefs signed by the North American/European donor organization. For both perceived quality and reported instrumental use, these analyses found that policy briefs signed by the African university (scientific authority) were associated with lower scores than policy briefs signed by the North American/European university. CONCLUSIONS: The results confirm the significant influence of sources on perceived global health knowledge and the intersectionality of sources of influence. This analysis allows us to learn more about organizations in global health leadership, and to reflect on the implications for knowledge translation practices.

RéSUMé: CONTEXTE: Les injustices épistémiques sont de plus en plus décriées dans le domaine de la santé mondiale. Cette étude vise à déterminer si la source des connaissances influence la perception de ces connaissances et la volonté de les utiliser. MéTHODES: L'étude suit un devis expérimental randomisé dans lequel les participant·es ont été assigné·es au hasard à l'une des sept notes politiques conçues avec le même contenu scientifique, mais avec différentes organisations présentées comme autrices. Chaque organisation était représentative d'une autorité financière, scientifique ou morale. Pour chaque type d'autorité, deux organisations étaient proposées : l'une nord-américaine ou européenne, l'autre africaine. RéSULTATS: Les résultats montrent que le type d'autorité et la localisation des organisations autrices ne sont pas significativement associés à la qualité perçue et à l'utilisation instrumentale déclarée. Toutefois, des interactions entre le type d'autorité et la localisation étaient significatives. Ainsi, les analyses stratifiées ont mis en évidence que pour la qualité perçue, les notes de politique signées par l'organisme bailleur (autorité financière) africain obtenaient de meilleurs scores que les notes de politique signées par l'organisme bailleur nord-américain / européen. Tant pour la qualité perçue que pour l'utilisation instrumentale déclarée, ces analyses stratifiées ont révélé que les notes de politique signées par l'université africaine (autorité scientifique) étaient associées à des scores plus faibles que les notes de politique signées par l'université nord-américaine/européenne. INTERPRéTATION: Les résultats confirment l'influence significative des sources sur la perception des connaissances en santé mondiale et rappellent l'intersectionnalité de l'influence des sources d'autorité. Cette analyse nous permet à la fois d'en apprendre davantage sur les organisations qui dominent la scène de la gouvernance mondiale en santé et de réfléchir aux implications pour les pratiques d'application des connaissances.

Promoting better functioning among children exposed to high levels of family adversity: the protective role of childcare attendance.

BACKGROUND: Children exposed to early adversity are vulnerable to cognitive impairments and externalizing behaviors. Attending childcare may, however, partly buffer this detrimental effect by providing social and cognitive stimulation in a secure environment. The aims of this study were (a) to determine whether the association between exposure to adversity and later externalizing behaviors is mediated by children's cognitive abilities, and (b) to examine if childcare attendance moderates this mediation-thereby highlighting a protective function of children's childcare attendance. METHODS: Data come from the Avon Longitudinal Study of Children and Parents (N = 6,149). Exposure to adversity was assessed by maternal reports three times from the second trimester of the mother's pregnancy to the child's fourth year of age. Childcare attendance was assessed on four occasions between eight months and three years of age. Factors explaining differences in childcare attendance were controlled using propensity score weights. Children's cognitive abilities were assessed by the Weschler Intelligence Scale for Children at eight years of age, and externalizing behaviors were reported by mothers using the Development and Well-Being Assessment interview at 10, 13, and 15 years of age. RESULTS: Notably, lower cognitive abilities partly accounted for the higher levels of externalizing behaviors in adolescents exposed to adversity (B indirect effect = 0.02, 95% CI = 0.007-0.03, p < .01). Importantly, childcare attendance moderated this indirect effect. For children exposed to adversity, being in maternal care was associated with lower cognitive abilities which were related to higher levels of externalizing behaviors. On the contrary, for children exposed to adversity, attending childcare was associated with higher cognitive abilities which were linked to lower levels of externalizing behaviors. CONCLUSIONS: Easily accessible community childcare may be a relatively low-cost public health strategy to prevent the emergence of externalizing behavioral problems in adolescence through its positive effects on cognitive abilities.

How to talk so kids will listen & listen so kids will talk: a randomized controlled trial evaluating the efficacy of the how-to parenting program on children's mental health compared to a wait-list control group.

BACKGROUND: Basic parenting research reveals that child mental health is associated with optimal parenting, which is composed of three key dimensions (structure, affiliation and autonomy support). The present study aims to test the efficacy of the parenting program "How to talk so kids will listen & listen so kids will talk" (French version), thought to address all of these dimensions, in promoting children's mental health. We predict that the How-to Parenting Program will promote child mental health by fostering optimal parenting. METHODS: In this randomized controlled trial (RCT), the seven-week parenting group was offered to parents of 5- to 12-year-old children, in their local grade school. Children's mental health assessments were questionnaire-based (parent, child and teacher reports) and took place at pre- (T1) and post- (T2) intervention as well as at 6-month (T3) and 1-year (T4) follow-ups. We compared children whose parents took part in the program with children whose parents did not take part in it until the completion of the trial (i.e., 1 year wait-list control groups). The primary outcome is children's psychological problems (externalizing and internalizing). Secondary outcomes include parenting, the putative mediator of the expected benefits of the program on child mental health, as well as positive indicators of child mental health (strengths and subjective well-being) and parents' own mental health. DISCUSSION: To our knowledge, this is the first RCT to test the efficacy of the "How to talk so kids will listen & listen so kids will talk" program in promoting child mental health. In addition to the close correspondence between basic parenting research and the selected program, strengths of this study include its feasibility, monitoring of potentially confounding variables, ecological validity and inclusion of positive indicators of mental health. TRIAL REGISTRATION: Current clinical trial number is NCT03030352 . Ongoing study, retrospectively registered on January 2017. No amendment to initial protocol.

Improving the implementation of KiVa antibullying program with tailored support: Study protocol for a cluster randomized controlled trial.

BACKGROUND: There are no evidence-based models to support the implementation of school-based bullying prevention programs. Our primary objective is to examine the impact of tailored support on the implementation of the KiVa antibullying program. Our second objective is to evaluate whether the offered support influences student outcomes (e.g., victimization, bullying perpetration). We also assess the cost-effectiveness of the provided support and conduct a process evaluation. METHODS: In a cluster randomized control trial (cRCT), we compare program fidelity between schools that receive implementation support and those that do not. Twenty-four (N = 24) schools in Finland were randomized to either the IMPRES condition (receiving support, n = 12) or the control group (KiVa as usual, n = 12). In the IMPRES condition, pre-assessment and staff training were organized, and a selected team of staff members received four mentoring sessions during one academic year. Staff and students answer questionnaires at the end of school year 0, at post-intervention (year 1) and again at the 1-year follow-up (year 2). Our primary outcomes concern two main program components - universal and indicated actions - reflecting program fidelity. As secondary outcomes, we examine the level of bullying victimization and perpetration as well as students' perception of several program fidelity indicators. Finally, we assess several tertiary outcomes, collect resource data and conduct qualitative interviews to perform additional analyses. CONCLUSION: This trial will inform us of whether implementation support can boost program fidelity and have a distal impact on bullying prevalence. TRIAL REGISTRATION: ISRCTN15558617 https://doi.org/10.1186/ISRCTN15558617.

The Influence of Educational Determinants on Children's Health: A Scoping Review of Reviews.

Objectives: Education is one of the most important social determinants shaping the development and wellbeing of children. The purpose of this review of reviews is to inform policymakers, practitioners and public health stakeholder involved in developing child-friendly policies outside of the healthcare system. Methods: We carried out a scoping review of reviews. It included 32 reviews. Results: We identified four main categories of educational determinants in relation to children's health: 1) the organization and structure of educational activities, 2) the interpersonal relations in the educational facilities and structures, 3) the spatial environment of educational facilities and structures, 4) social inequalities in the educational facilities and structures. This last category highlighted the capacity of education system to act on inequalities derived from the way social structures are organized. Conclusion: We suggest a conceptual framework for action which distinguishes structural determinant (gender, race, social class, etc.) and structuring determinant (public policy, systems of governance, organization of cultures/values consideration). Finally, we discuss on how these social structures and structuring determinants influence the intermediary educational determinants collated in the review.

Hair steroid before and after COVID-19 in preschoolers: the moderation of family characteristics.

BACKGROUND: Frequent or prolonged exposure to stressors may jeopardize young children's health. The onset of the COVID-19 pandemic, coupled with disruptions in daily routines and social isolation resulting from public health preventive measures, have raised concerns about its potential impact on children' experienced stress, particularly for young children and vulnerable families. However, whether the pandemic was accompanied by changes in physiological stress remains unknown as perceived stress is not a good proxy of physiological stress. This study examined if preschoolers showed increasing hair steroid concentrations following the onset of the COVID-19 pandemic and whether family characteristics may have exacerbated or buffered these changes. METHODS: 136 preschoolers (2-4 years) provided hair for steroid measurement (cortisol, dehydroepiandrosterone (DHEA), cortisone, cortisol-to-DHEA ratio, cortisol-to-cortisone ratio) in October-November 2019 (T0) and in July-August 2020 (T1). A 2-centimeter hair segment was analyzed, reflecting steroid production over the two months leading up to collection. Family income, conflict resolution and lack of cohesion, as well as parents' COVID-19 stress were reported by parents. Linear mixed models for repeated measures and Bayes factors were used. RESULTS: No significant changes were noted from before to after the onset of the COVID-19 pandemic for most hair steroids. However, a moderating role of family conflict resolution was noted. Children living with parents with a better ability to resolve conflicts had lower levels of DHEA compared to those who had more difficulty managing conflicts. Additionally, lower levels of family cohesion and income were linked to some steroids, especially DHEA, suggesting that these factors may relate to children's physiological stress. Finally, boys had higher DHEA levels than girls. CONCLUSION: Our findings suggest that stress biomarkers were comparable from before to during the COVID-19 pandemic. This observation holds true despite the pandemic being perceived by many as a novel, unpredictable, and potentially threatening event. Findings further suggest that family characteristics are associated with hair steroid, especially DHEA, which deserves further investigation.

Latent Transitions of Census-level Deprivation and Network Analysis of Conduct Problem Behaviours.

Conduct problems are more prevalent in neighbourhoods that have a vulnerable structure (e.g., high neighbourhood-level deprivation) and disarranged interpersonal characteristics (e.g., low social cohesion and informal social control at the neighbourhood level). However, as an indicator of neighbourhood structure, neighbourhood deprivation has typically not been assessed longitudinally and solely based on neighbourhood-level socioeconomic status rather than a wide variety of census-level deprivation indicators. Also, few studies have examined which CD behaviours (e.g., stealing) interplay with neighbourhood risks (e.g., low social cohesion). In this study, latent transitions of neighbourhood-level deprivation patterns, based on census-level information, were estimated between age 12.5 and 15.5 using the Avon Longitudinal Study of Parents and Children (ALSPAC). In network models, we employed multi-informant variables and estimated interplays between mother-reported CD behaviours and child-reported social cohesion, informal social control and deviant peer affiliations within different patterns of the latent neighbourhood-level deprivation transitions. We identified three constant deprivation patterns: deprived, intermediate and low pattern. In the deprived pattern, the CD behaviour "bullying" had the highest interplay with lack of social cohesions, social control, and high deviant peer affiliation. In contrast, non-violent CD behaviours: "lying" and "staying after dark ", showed importance in the intermediate and low patterns, respectively. Regardless of deprivation patterns, social cohesion played a protective role, whereas affiliation with deviant peers involved in property crime was a risk factor for CD behaviours. The identified CD behaviours can serve as a screening tool, and interventions increasing social cohesion might mitigate CD development.

Childcare Attendance and Academic Achievement at Age 16 Years.

Importance: Low school preparedness is linked to high school dropout, poor employment, and negative outcomes. Childcare attendance may increase school readiness and foster academic achievement. Objective: To explore whether childcare attendance was associated with academic achievement at the end of compulsory schooling (age 16 years in the UK), whether maternal education level was a moderator, and the benefit-cost ratio of childcare regarding productivity returns of academic achievement. Design, Setting, and Participants: In this cohort study, data were included from the Avon Longitudinal Study of Parents and Children (ALSPAC) born from April 1991 to December 1992 and the UK National Pupil Database for examination results. Data on academic achievement at age 16 years were available for 11 843 participants. Data were collected from June 2006 to June 2008, and data were analyzed from September 2019 to May 2020. Exposures: On average, 3.7%, 5.9%, and 90.4% attended childcare full time, part time, and less than 10 hours per week, respectively. Maternal education was assessed by questionnaire during pregnancy. Analyses included weights for population representativeness and propensity score weights to account for parental selection into childcare. Main Outcomes and Measures: Academic achievement was defined as no certificate, Level 1 General Certificate of Secondary Education (GCSE; limited training), or Level 2 GCSE (qualification for academic post-16 education; high school diploma equivalent). Lifetime productivity return estimates were withdrawn from previous economic analysis based on pupil's qualifications. Results: Of 14 541 children in the ALSPAC study, 8936 children had complete data on childcare attendance, academic achievement, and maternal education levels. Of these, 4499 (50.3%) were male. Attending childcare was associated with higher probabilities of obtaining a Level 1 or 2 GCSE qualification (Level 1: relative risk, 1.41; 95% CI, 1.16-1.73; Level 2: relative risk, 1.62; 95% CI, 1.30-2.01); however, this association was moderated by the child's maternal education level. When children of mothers with low education attended childcare, their probability of no GCSE qualification went from 28.9% (95% CI, 26.8-31.0) to 20.3% (95% CI, 18.0-22.8), whereas children of mothers with higher education had a probability of no qualification of less than 10% regardless of childcare attendance. The benefit-cost ratio for each £1 (US $1.40) invested in full-time childcare attendance for children of mothers with low education was £1.71 (95% CI, 1.03-2.45; US $2.39; 95% CI, 1.44-3.43) for those who reached a Level 2 GCSE qualification. Conclusions and Relevance: Promoting universal childcare with facilitated access for children of lower socioeconomic backgrounds deserves to be considered as a way to reduce the intergenerational transmission of low academic achievement.

Examining the impact of a social skills training program on preschoolers' social behaviors: a cluster-randomized controlled trial in child care centers.

BACKGROUND: Preschoolers regularly display disruptive behaviors in child care settings because they have not yet developed the social skills necessary to interact prosocially with others. Disruptive behaviors interfere with daily routines and can lead to conflict with peers and educators. We investigated the impact of a social skills training program led by childcare educators on children's social behaviors and tested whether the impact varied according to the child's sex and family socio-economic status. METHODS: Nineteen public Child Care Centers (CCC, n = 361 children) located in low socio-economic neighborhoods of Montreal, Canada, were randomized into one of two conditions: 1) intervention (n = 10 CCC; 185 children) or 2) wait list control (n = 9 CCC; 176 children). Educators rated children's behaviors (i.e., disruptive and prosocial behaviors) before and after the intervention. Hierarchical linear mixed models were used to account for the nested structure of the data. RESULTS: At pre-intervention, no differences in disruptive and prosocial behaviors were observed between the experimental conditions. At post-intervention, we found a significant sex by intervention interaction (ß intervention by sex = - 1.19, p = 0.04) indicating that girls in the intervention condition exhibited lower levels of disruptive behaviors compared to girls in the control condition (f2 effect size = - 0.15). There was no effect of the intervention for boys. CONCLUSIONS: Girls may benefit more than boys from social skills training offered in the child care context. Studies with larger sample sizes and greater intervention intensity are needed to confirm the results. TRIAL REGISTRATION: Current clinical trial number is ISRCTN84339956 (Retrospectively registered in March 2017). No amendment to initial protocol.

Impact of a social skills program on children's stress: A cluster randomized trial.

BACKGROUND: Most preschool children in Western industrialized countries attend child care during the day while parents work. Studies suggest that child care may be stressful to young children, perhaps because they still lack the social skills to interact daily in a group setting away from parents. This gap in social abilities may be greater for children in lower-income families, who may face more adversity at home, with fewer resources and more social isolation. METHODS: We conducted a cluster-randomized controlled trial in 2013-2014 to test whether a social skills intervention led by early childhood educators within the child care center could reduce diurnal cortisol levels to more typical patterns expected of children this age. We randomized 19 public child care centers (n = 361 children) in low-income neighborhoods of Montreal, Canada, to either: 1) the Minipally program - intervention group (n = 10 centers; 186 children), or 2) waiting list - control group (n = 9 centers; 175 children). Saliva samples for cortisol levels were collected 3 times/day, pre- and post-implementation. The Minipally puppet program consists of 2 workshops/month for 8 months for the development of social skills and self-regulation in 2-5-year-olds, with reinforcement activities between workshops. Educators received 2-days' training and 12 h' supervision in Minipally. RESULTS: Linear mixed models for repeated measures revealed a significant interaction between intervention status and time of day of cortisol sampling (ß = -0.18, p = 0.04). The intervention group showed patterns of decreasing diurnal cortisol secretion (ß = -0.32, p < 0.01), whereas the control group showed increasing slopes (ß = 0.20, p < 0.01). Moreover, family income was a moderator; children in lower-income families benefited most from the intervention. CONCLUSION: Results suggest that a social skills training program, when integrated into a preschool education curriculum, can foster an environment more conducive to typical childhood patterns of cortisol secretion.

Testing the impact of a social skill training versus waiting list control group for the reduction of disruptive behaviors and stress among preschool children in child care: the study protocol for a cluster randomized trial.

BACKGROUND: Most preschoolers growing up in western industrialized countries receive child care services (CCS) during the day, while their parents are at work. Meta-analytic data suggest that CCS represent a stressful experience for preschoolers. This may be because preschoolers have not yet developed the social skills necessary to cope with the new and rapidly fluctuating social contexts of CCS. We tested the effectiveness of a child care-based social skill training program aiming to improve children's social behaviors and reduce the stress they experience. METHOD AND DESIGN: We used a cluster randomized control trial (cRCT) to compare children's social behaviors and stress levels in pre- and post-intervention according to whether they received a social skill training intervention or not. Nineteen (n = 19) public CCS (n = 362, 3-years-old preschoolers) of underprivileged neighborhoods (Montreal, Canada) were randomized to one of two conditions: 1) social skills training (n = 10 CCS); or 2) waiting list control group (n = 9 CCS). Educators in the intervention group conducted bi-weekly social skills training sessions over a period of 8 months. The intervention covered four topics: making social contacts, problem solving, emotional self-regulation, as well as emotional expression and recognition. Main outcome measures included preschoolers' disruptive (e.g. aggression, opposition, conflicts) and prosocial behaviors (e.g. sharing toys, helping another child), and stress levels assessed by salivary cortisol sampling at pre and post intervention assessments. Educators' practices will be tested as potential mediators of the expected changes in behaviors and neuroendocrine stress. DISCUSSION: To our knowledge, this is the first cRCT to test the effectiveness of a child care based social skill training program on the reduction of disruptive behaviors and levels of stress. Significant challenges include the degree of adherence to the intervention protocol as well educators and preschoolers' turnover. TRIAL REGISTRATION: Current clinical trial number is ISRCTN84339956 (Ongoing study, Retrospectively registered on March 2017) No amendment to initial protocol.