A Dietary Pattern With More Fruits and Vegetables in Children of Mothers Who Immigrated to the United States From Latin America Is Associated With Healthful Nutrient Intake and Weight Status.

BACKGROUND: Children from families who immigrated to the United States may consume a lower-quality diet compared with their US-born peers. However, specific features of their dietary patterns, which could be a focus for improving diet quality, are not well-studied. OBJECTIVE: The aim of this study was to examine dietary patterns that distinguish interpersonal variability in dietary intake and explore the association of dietary patterns with nutrient intake and weight status. DESIGN: This study was a cross-sectional analysis of baseline data from the Live Well randomized controlled trial collected between 2009 and 2010. PARTICIPANTS/SETTING: Study participants included 313 children (3-12 years) whose mothers immigrated to the United States from Latin America and resided in Somerville, Massachusetts. MAIN OUTCOME MEASURES: Dietary patterns (derived using principal component analysis); nutrient intake (derived from dietary data collected using the Block Food Screener); and weight status (categorized using body mass index z score based on measured height and weight). STATISTICAL ANALYSES PERFORMED: Nutrient intake levels were compared across quartiles for dietary patterns using analysis of covariance. Multivariable logistic or linear regression models were used to determine the associations between dietary pattern scores and odds of overweight or obesity or z scores. RESULTS: Two dietary patterns emerged: "fruits and vegetables" and "meat and sweets." Highest adherence to the fruits and vegetables pattern was associated with more healthful nutrient intake and lower odds of having overweight or obesity (odds ratio 0.37; 95% CI 0.16 to 0.98), but not body mass index z score (ß = -.07; 95% CI -.51 to 0.36) compared with the lowest adherence. Adherence to the meat and sweets pattern was associated with less healthful nutrient intake but not with the odds of experiencing overweight or obesity (odds ratio 0.48; 95% CI 0.16 to 1.46). CONCLUSIONS: A healthful dietary pattern in children of families who immigrated to the United States from Latin America may include a variety of fruits and vegetables. Longitudinal studies should be conducted to further assess the role of dietary intake patterns on the health of these children.

Timeliness of Early Identification and Referral of Infants with Social and Environmental Risks.

The Early Intervention Parenting Partnerships (EIPP) program is a home visiting program that provides home visits, group services, assessments and screenings, and referrals delivered by a multidisciplinary team to expectant parents and families with infants who experience socioeconomic barriers, emotional and behavioral health challenges, or other stressors. The present study examines whether EIPP successfully meets its aims of screening families for social and environmental factors that may increase the risk of children's developmental delays and connect them to the larger statewide early intervention (EI) system relative to families with similar background characteristics who do not receive EIPP. Coarsened exact matching was used to match EIPP participants who enrolled between 2013 and 2017 to a comparison group of families identified from birth certificates. Primary study outcomes including EI referrals, evaluations, and service receipt for children from 3 months to 3 years were measured using EI program data. Secondary outcomes included EI referral source, EI eligibility criteria (e.g., presence of biological, social, or environmental factors that may increase later risk for developmental delay), and information on service use. Impacts were assessed by fitting weighted regression models adjusted for preterm birth and maternal depression and substance use. EIPP participants were more likely than the comparison group to be referred to, evaluated for, and receive EI services. EIPP facilitated the identification of EI-eligible children who are at risk for developmental delays due to social or environmental factors, such as violence and substance use in the home, child protective services involvement, high levels of parenting stress, and parent chronic illness or disability. EIPP serves as an entry point into the EI system, helping families attain the comprehensive supports they may need to optimize their well-being and enhance children's development.

Improving connections to early childhood systems of care via a universal home visiting program in Massachusetts.

Welcome Family is a universal, short-term nurse home visiting program designed to promote optimal maternal and infant physical and mental well-being and provide an entry point into the early childhood system of care to all families with newborns up to 8 weeks old living in defined communities in Massachusetts. The present study examines whether: 1) Welcome Family meets its goal of successfully connecting families to two early childhood programs-evidence-based home visiting (EBHV) and early intervention (EI)-relative to families with similar background experiences who do not participate in Welcome Family, and 2) whether these impacts are conditional on families' race and ethnicity and their primary language-two characteristics that are related to structural racism and health inequities. The study used coarsened exact matching (CEM) based on birth certificate data to match Welcome Family participants who enrolled during 2013-2017 to mothers and their infants living in the home visiting catchment areas who did not receive home visiting during the study period. Primary study outcomes included enrollment in any EBHV program supported by the Massachusetts Maternal, Infant, and Early Childhood Home Visiting (MA MIECHV) program up to age 1 year, measured using MA MIECHV home visiting program data, and EI service receipt for children aged up to age 3 years, measured using EI program data. Impacts were assessed by fitting weighted regression models adjusted for preterm birth, maternal depression, and substance use. Mothers' race, ethnicity, and language were included in the model as moderators of Welcome Family impacts on enrollment in EBHV and EI. Welcome Family participants (n = 3,866) had more than double the odds of EBHV enrollments up to age 1 and had 1.39 greater odds of receiving EI individualized family service plans (IFSPs) up to age 3 relative to the comparison group (n = 46,561). Mothers' primary language moderated Welcome Family impacts on EBHV enrollments. Universal, short-term programs such as Welcome Family may be an effective method of ensuring families who could benefit from more intensive early childhood services are identified, engaged, and enrolled.

Effects of a Home Visiting Program on Parenting: Mediating Role of Intimate Partner Violence.

Young women aged 18 to 24 years are in the highest risk group for intimate partner violence (IPV), and adolescent mothers are at particularly high risk for IPV and for risky health behaviors. Exposure to IPV may contribute to parenting stress and risky behaviors, and may compromise parenting behavior and healthy child development. The present study examined whether program effects of a statewide home visiting program for adolescent parents on young mothers' parenting stress and risky behaviors measured 2 years post program enrollment were mediated by program effects on their exposure to IPV measured 1 year post enrollment. Using longitudinal data from a subsample of young mothers (n = 448; 58% program, 42% control) who participated in a randomized controlled trial evaluation of a statewide home visiting program, Healthy Families Massachusetts (HFM), we estimated path analyses to examine whether home visiting program effects observed on IPV mediated home visiting program effects on subsequent assessments of parenting distress and mothers' risky behaviors. Findings indicated that IPV mediated associations between home visiting program effects on mothers' parenting distress and risky behavior. Although most newborn home visiting programs do not have an explicitly stated goal of reducing IPV, helping mothers and their partners to reduce violent behavior can have further-reaching impacts on other key goals of home visiting programs, such as parenting stress and risky behaviors.

Maternal Engagement in a Home Visiting Program as a Function of Fathers' Formal and Informal Participation.

Home visiting programs support new and expecting parents by strengthening parenting practices, improving parental and child health and well-being, and preventing child maltreatment. Participant retention is often a challenge for home visitation, particularly for young families, potentially reducing program impact. Father engagement in services may be one avenue for supporting continued program take-up for young parents. The current study examined associations between fathers' formal and informal participation in an infant home visiting program and mothers' take-up of home visits and whether these associations differed depending on mothers' relationship status at enrollment or timing of enrollment. Results showed that fathers' participation in home visiting supported maternal retention, particularly when fathers were formally enrolled. These associations depended on mothers' relationship status at enrollment but not on whether they enrolled pre- or postnatally. These findings have direct implications for home visiting programs, both in supporting maternal retention and in informing the recruitment and engagement of fathers.

Relationship types among adolescent parents participating in a home-visiting program: A latent-transition analysis.

Young parents (less than 25 years of age) have been shown to have especially low rates of father involvement and union stability. However, research has also shown that parenting experiences of young fathers may not be uniform. There is a need for more research that assesses both the multidimensionality of relationship typologies and their temporality. Using a large longitudinal sample of low-income, young mothers enrolled in a randomized control study of a home-visitation program (n = 704; 61% program, 39% control), we evaluated how mother-father relationship dynamics changed over time. Ten mother-reported indicators of relationships (e.g., coresidence, marital status, types of father support) were used to conduct a latent-class analysis of relationship types. A 4-class solution was identified at each time point: Single Parent, Supportive Nonresident Partner, Supportive Resident Partner, and Questioning/Ambivalent Coupling. Latent-transition analyses were used to evaluate stability of relationships across 2 years. At each transition, a large proportion of women moved from one relationship class to another, indicating heterogeneity in relationship dynamics of adolescent parents. Results revealed the potential of a home-visiting program targeted at young parents to favorably promote more stable and supportive mother-father relationships and coparenting arrangements.

Seven years later: effects of a neighborhood mobility program on poor Black and Latino adults' well-being.

This study explored program effects on adults' well-being seven years following the implementation of a court-ordered neighborhood mobility program. Low-income black and Latino adults residing in poor, segregated neighborhoods in Yonkers, New York were randomly selected to relocate to publicly funded townhouses in middle-class neighborhoods within the city. Adults who moved (n = 141) and demographically similar adults who were not selected to move (n = 106) were interviewed. Data indicate that 85 percent of adults who moved to the new housing remained there at follow-up. Results revealed that adults who moved resided in neighborhoods with higher collective efficacy and less disorder and danger but had fewer neighborhood social ties than adults who stayed in poor neighborhoods. Movers were also more likely to work and less likely to receive welfare than nonmovers. Adults who remained in low-poverty neighborhoods at the time of the follow-up reported better physical health than adults residing in poor neighborhoods, but mental health did not vary by neighborhood.

Does the neighborhood context alter the link between youth's after-school time activities and developmental outcomes? A multilevel analysis.

This article examines links between different measures of after-school time activity participation (5 specific activities and breadth) on youth's developmental outcomes (anxiety/depression, delinquency, and substance use) over 6 years and whether these links are moderated by neighborhood-level variables. The sample (N=1,315) of 9- and 12-year-old youth was drawn from the Project on Human Development in Chicago Neighborhoods (PHDCN), a multilevel, longitudinal study of youth from 80 Chicago neighborhoods. Findings revealed that different types of activities and patterns of participation over time were associated with outcomes for youth and that, to some extent, these outcomes varied with neighborhood characteristics. In brief, sports participation was associated with fewer anxious/depressed symptoms, higher average delinquency scores, and increased substance use-both average scores and growth over time. Participation in the arts and student government were negatively associated with average substance use and attenuated increases in usage over time. Participation in community-based clubs was positively associated with youth's anxiety/depression in violent neighborhoods only, whereas church groups were protective against substance use in nonviolent neighborhoods. The direction of the influence of breadth of participation was nonlinear for delinquency such that delinquency scores were highest among youth who engaged in an average number of activities.

Neighborhood poverty and public policy: a 5-year follow-up of children's educational outcomes in the New York City moving to opportunity demonstration.

Data from the Moving to Opportunity Program, a randomized mobility experiment in which a subset of low-income minority families living in public housing in high-poverty neighborhoods were given vouchers to move to low-poverty neighborhoods, were used to evaluate 1 policy approach for improving children's educational outcomes. Four hundred twenty-five New York City children were seen 2 1/2 and 5 years following relocation (mean age=14.64 years, SD=3.21 years). Analyses examining program effects on 5-year educational outcomes, accounting for 2 1/2-year outcomes, revealed that program effects on adolescent boys' achievement found at 2 1/2 years were not sustained at 5 years. Rather, male and female youths 14-20 years of age in low-poverty neighborhoods reported lower school grades and engagement relative to youths in high-poverty neighborhoods. From a policy standpoint, the complexity of enhancing low-income minority children's educational outcomes is underscored by the multiple dynamics involved--family, neighborhood, housing, and school.

Short-term effects of moving from public housing in poor to middle-class neighborhoods on low-income, minority adults' outcomes.

This study reports results from a quasi-experimental residential mobility study in Yonkers, NY, in which low-income minority families residing in public and private housing in high-poverty neighborhoods were randomly assigned via lottery to relocate to publicly funded attached rowhouses in seven middle-class neighborhoods. One hundred seventy-three Black and Latino families who moved and 142 demographically similar families who remained in the original high-poverty neighborhoods were interviewed approximately 2 years after movers relocated; no baseline data were available. Multiple regression analyses controlling for individual- and family-level background characteristics revealed that adults who moved to low-poverty neighborhoods were less likely to be exposed to violence and disorder, experience health problems, abuse alcohol, receive cash assistance, and were more likely to report satisfaction with neighborhood resources, experience higher housing quality, and be employed, when compared with adults who remained in high-poverty neighborhoods. Adults who moved to low-poverty neighborhoods were less likely than those who stayed in high-poverty neighborhoods to socialize informally with neighbors. No program effects were found on adults' symptoms of depression and anxiety. These early program effects inform housing policy initiatives for low-income families.