The heart of the matter: Developing the whole child through community resources and caregiver relationships.

Numerous developmental scholars have been influenced by the research, policies, and thinking of the late Edward Zigler, who was instrumental in founding Head Start and Early Head Start. In line with the research and advocacy work of Zigler, we discuss two models that support the development of the whole child. We begin by reviewing how adverse and protective experiences "get under the skin" and affect developmental trajectories and risk and resilience processes. We then present research and examples of how experiences affect the whole child, the heart and the head (social, emotional, cognitive, and physical development), and consider development within context and across domains. We discuss examples of interventions that strengthen nurturing relationships as the mechanism of change. We offer a public health perspective on promoting optimal development through nurturing relationships and access to resources during early childhood. We end with a discussion of the myth that our current society is child-focused and argue for radical, essential change to make promoting optimal development for all children the cornerstone of our society.

The effect of a mindfulness-based stress intervention on neurobiological and symptom measures in adolescents with early life stress: a randomized feasibility study.

BACKGROUND: Early life stress (ELS) has been linked to poor mental and physical health outcomes in adolescence and adulthood. Mindfulness reduces symptoms of depression and anxiety and improves cognitive and social outcomes in both youth and adults. However, little is known whether mindfulness can mitigate against the adverse neurobiological and psychological effects of ELS. This study aimed to examine the feasibility of conducting a group mindfulness intervention in adolescents with ELS and provide preliminary indication of potential effects on stress-related biomarkers and mental health symptoms. METHODS: Forty adolescents were randomized to receive either eight sessions of Mindfulness-Based Stress Reduction for Teens in group format (MBSR-T; n = 21) or Treatment as Usual Control group (CTRL; n = 17). Outcomes were assessed at baseline and follow-up and included measures associated with neurobiological functioning (immune and endocrine biomarkers) and self-reported mental health (depressive) symptoms. Linear mixed effects models were used to assess the effects of group and time on these outcome measures. RESULTS: Sixteen of the 21 adolescents completed the intervention, attending an average of 6.5 sessions. The model examining cortisol responses to stress induction revealed medium effects trending toward significance (Cohen's d = .56) for anticipatory cortisol levels in the MBSR-T relative to CTRL groups. No significant effects were found in models examining C-reactive protein or interleukin 6 inflammatory markers. The model examining depressive symptoms revealed a medium effect for symptom reduction (Cohen's d = .69) in the MBSR-T relative to CTRL groups. CONCLUSIONS: This study demonstrated feasibility of conducting a group-based MBSR-T intervention for adolescents with ELS. There was some evidence for efficacy on a symptom level with potential subtle changes on a biological level. Future larger studies are needed to determine the efficacy of group-based mindfulness interventions in this population. TRIAL REGISTRATION: Identifier # NCT03633903 , registered 16/08/2018.

Integrating and synthesizing adversity and resilience knowledge and action: The ICARE model.

This article proposes a model for understanding the effects of adverse childhood experiences (ACEs) as dynamic and interrelated biobehavioral adaptations to early life stress that have predictable consequences on development and health. Drawing upon research from multiple theoretical and methodological approaches, the intergenerational and cumulative adverse and resilient experiences (ICARE) model posits that the negative consequences of ACEs result from biological and behavioral adaptations to adversity that alter cognitive, social, and emotional development. These adaptations often have negative consequences in adulthood and may be transmitted to subsequent generations through epigenetic changes as well as behavioral and environmental pathways. The ICARE model also incorporates decades of resilience research documenting the power of protective relationships and contextual resources in mitigating the effects of ACEs. Examples of interventions are provided that illustrate the importance of targeting the dysregulated biobehavioral adaptations to ACEs and developmental impairments as well as resulting problem behaviors and health conditions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Adverse and Protective Childhood Experiences and Parenting Attitudes: the Role of Cumulative Protection in Understanding Resilience.

Theory and research indicate that adverse childhood experiences (ACEs) are linked to negative parenting attitudes and behaviors. We posit that protective and compensatory experiences (PACEs) in childhood buffer the negative effects of ACEs on later parenting. To test this premise, the present study examined associations between ACEs, PACEs, and attitudes towards nurturing and harsh parenting in an ethnically diverse sample of parents with children of various ages (N = 109; 65% mothers, 35% fathers; M age = 38). Parents completed a widely used parenting attitudes questionnaire and the ACEs and PACEs surveys. PACEs were negatively correlated with ACEs and positively correlated with nurturing parenting attitudes and parent income and education levels. Linear regression models indicate that higher PACEs, ACEs, and family income and less harsh parenting attitudes predict nurturing parenting attitudes. In contrast, higher ACEs and less nurturing attitudes were correlated with harsh parenting attitudes. As expected, moderation analyses indicated that the association between ACEs and harsh parenting attitudes was conditional upon the level of PACEs. When PACE scores were low (M - 1 SD), but not when PACE scores were average or high (M + 1 SD), ACEs were associated with harsh parenting attitudes, suggesting a buffering effect of PACEs on negative parenting attitudes. These findings support the importance of including protective as well as adverse childhood experiences when assessing the role of childhood experiences on parenting attitudes and practices. Implications of these findings for researchers and practitioners are discussed, as well as new directions for PACEs research using a cumulative protection approach.

Childhood Adversity and Perceived Distress from the COVID-19 Pandemic.

Childhood exposure to adversity may increase an individual's reactivity to subsequent stressors. In this paper, we examine how adverse childhood experiences (ACEs) are associated with experiencing greater perceived distress during the pandemic. In this volunteer clinical cohort study, 177 pregnant women (ages 16-38) were recruited from two university-affiliated perinatal clinics located in a small metropolitan city between October 2017 and May 2018. Longitudinal data collection is ongoing. The current study includes the 101 women who participated through the eighth and most recent survey conducted in mid-April 2020. OLS regression analyses were used to examine the association between childhood adversity and pandemic-related distress. We found that ACE scores were associated with higher levels of distress (b = .08; se = .03; p < .01) when controlling for demographic characteristics. The addition of loneliness to the model fully mediates the association between ACEs score and distress. Findings suggest that adverse childhood experiences influence COVID-19-related distress due to greater social isolation. Those who had greater adversity during childhood may be less likely to have the social connectedness needed to reduce distress due to the pandemic.

The impact of positive parenting behaviors and maternal depression on the features of young children's home language environments.

This study investigated the associations between maternal depression when infants were 3 to 11 months old (M = 6 months), and positive parenting behaviors when children were between 12 and 22 months (M = 17 months) and the home language environment assessed when children were 18 to 28 months old (M = 23.5 months) in a sample of 29 low-income mother-child dyads. After controlling for maternal education, only teaching behaviors remained a moderate and significant predictor of adult word counts. Observed teaching behaviors significantly predicted conversational turns and marginally predicted child vocalizations; effects sizes were small. Encouraging behaviors were a small and significant predictor of conversational turns and a marginally significant predictor of adult word counts. Maternal depression was a moderate and significant predictor of children's vocal productivity scores and a small, marginal predictor of conversational turns. These findings have important implications for parenting and children's language outcomes.

Targeting Parenting in Early Childhood: A Public Health Approach to Improve Outcomes for Children Living in Poverty.

In this article, the authors posit that programs promoting nurturing parent-child relationships influence outcomes of parents and young children living in poverty through two primary mechanisms: (a) strengthening parents' social support and (b) increasing positive parent-child interactions. The authors discuss evidence for these mechanisms as catalysts for change and provide examples from selected parenting programs that support the influence of nurturing relationships on child and parenting outcomes. The article focuses on prevention programs targeted at children and families living in poverty and closes with a discussion of the potential for widespread implementation and scalability for public health impact.

Associations between time spent sitting and cancer-related biomarkers in postmenopausal women: an exploration of effect modifiers.

PURPOSE: Despite evidence that prolonged periods of sitting may influence biological mediators of cancer development, few studies have considered these relationships in a cancer-specific context. METHODS: This cross-sectional study included 755 postmenopausal women enrolled in an ancillary study of the Women's Health Initiative. Plasma levels of Insulin-like growth factor-I (IGF-I), IGF-binding protein-3, leptin, insulin, C-peptide, C-reactive protein (CRP), and Interleukin (IL)-6 were measured. The time spent sitting per day was categorized as quartiles (Qs). The relationships between sedentary time and biomarkers were modified by race, physical activity, and exogenous estrogen use. RESULTS: IGF-I levels among African American (AA) women were higher than those of white women across the Qs of sedentary time. Likewise, IL-6 levels in AA women were higher than those in white women at Q3 and Q4 of sedentary time. IGFBP-3 levels were higher and insulin levels were lower across the Qs of sedentary time among women meeting guidelines for physical activity than women who were not. Additionally, CRP levels were higher among estrogen users than nonusers at Q1, Q2, and Q4 of sedentary time. CONCLUSIONS: These results suggest that relationship between time spent sitting and cancer-related biomarkers may not be simply linear, but differ in the context of effect modifiers.

Excess weight and physical health-related quality of life in postmenopausal women of diverse racial/ethnic backgrounds.

BACKGROUND: Studies of weight and health-related quality of life (HRQOL) generally focus on white populations. This analysis examines the association between clinical weight categories and physical HRQOL in five racial/ethnic groups of older women and determines the extent to which emotional/psychological (social support, caregiver burden) and physical health (diabetes, osteoarthritis) factors modify this relationship. METHODS: The cross-sectional analysis, completed in 2007, used baseline data from postmenopausal women enrolled in the Women's Health Initiative (WHI) during the 5-year recruitment period (1993-1998). RESULTS: Of 161,393 women, 83% were non-Hispanic white, 9% were African American, 4% were Hispanic/Latina, 3% were Asian/Pacific Islander, and <1% were American Indian/Alaska Native. Obesity (body mass index [BMI] > or =30 kg/m(2)) was most common in non-Asian minority groups. Regression modeling showed higher odds of poor physical HRQOL with increasing weight category in all groups. In the total sample, these odds were at least 6 times as high in women with class 3 obesity as in women of normal weight and were only mildly attenuated after the analysis adjusted for emotional/psychological factors. Further adjustment for physical health factors made odds ratio (OR) estimates drop from 2.36 to 1.59 for class 1 obesity and from 6.96 to 3.71 for class 3 obesity. This pattern generally persisted within each racial/ethnic group. CONCLUSIONS: Heavier weight negatively affects physical HRQOL in postmenopausal women across diverse racial/ethnic backgrounds. Weight-relevant physical health factors have a greater impact on this weight-HRQOL association than do emotional/psychological factors.

Using simulation to orient code blue teams to a new hospital facility.

OBJECTIVES: Prompt and successful cardiopulmonary resuscitation during a sudden cardiac arrest can be hindered by multiple variables, ie, ineffective communication, stress, lack of training, and an unfamiliar environment, such as a new hospital facility. The main objective of the study was to use high-fidelity simulations to orient Code Blue Teams (CBTs) to critical events in a new hospital facility. A secondary objective was to elucidate factors that may have contributed to responses by debriefing teams. METHODS: Mock Code Blue exercises using high-fidelity simulation were implemented in real workplace settings to orient CBTs to critical events. We measured arrival time of first responder, crash cart to code site, first six CBT responders, first chest compression, and first electrical shock. After each mock code, participants were debriefed to assess any barriers to effective response and decision making. RESULTS: Twelve mock codes were conducted at different locations of the new facility. Sixty-nine percent of the participants reported that the training was beneficial. The median time of arrival of the first responders was 42 seconds and the first CBT member was 66 seconds. The median time to initiation of chest compressions was 80 seconds, crash cart arrival was 68 seconds, and first electrical shock was 341 seconds. An additional outcome of the study was the identification of facility and systems issues that had the potential to impact patient safety. CONCLUSIONS: Clinical simulation can be effectively used to orient CBTs and identify critical safety issues in a newly constructed healthcare facility.