The Breast-Imaging Operations, Practices and Systems Inventory: A framework to examine mammography facility effects on screening in rural communities.

PURPOSE: Develop and test a measurement framework of mammogram facility resources, policies, and practices in Appalachia. METHODS: Survey items describing 7 domains of imaging facility qualities were developed and tested in the Appalachian regions of Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia. Medicare claims data (2016-2018) were obtained on catchment area mammogram services. Construct validity was examined from associations with facility affiliation, community characteristics, mammogram screening uptake, and market reach. Analyses were performed with t-tests and ANOVA. RESULTS: A total of 192 (of 377) sites completed the survey. Five factors were initially selected in exploratory factor analysis (FA) and refined in confirmatory FA: capacity, outreach & marketing, operational support, radiology review (NNFI = .94, GFI = 0.93), and diagnostic services (NNFI = 1.00, GFI = 0.99). Imaging capacity and diagnostic services were associated with screening uptake, with capacity strongly associated with catchment area demographic and economic characteristics. Imaging facilities in economically affluent versus poorer areas belong to larger health systems and have significantly more resources (P < .001). Facilities in economically distressed locations in Appalachia rely more heavily on outreach activities (P < .001). Higher facility capacity was significantly associated (P < .05) with larger catchment area size (median split: 48.5 vs 51.6), mammogram market share (47.4 vs 52.7), and screening uptake (47.6 vs 52.4). CONCLUSIONS: A set of 18 items assessing breast imaging services and facility characteristics was obtained, representing policies and practices related to a facility's catchment area size, market share, and mammogram screening uptake.

Factors Predictive of Being Bullies or Victims of Bullies in US Elementary Schools.

We analyzed a population-representative cohort (N=13,611; Mage at kindergarten, first, and second grade = 67.5, 79.5, and 91.5 months, respectively) to identify kindergarten to second grade factors predictive of being bullies or victims during third to fifth grade. We did so by estimating a block recursive structural equation model (SEM) with three sets of predictors. These were: (a) individual and school socio-demographics; (b) family distress and harsh parenting; and (c) individual behavior and achievement. Relations between each of the included variables and the bullying outcomes were simultaneously estimated within the SEM. Thus, each variable served as a control for estimating the effects of the other variables. We used robust standard errors to account for student clustering within schools. Results indicated that externalizing problem behavior strongly predicted being a bully ([ES] = .56, p<.001) and a victim (ES=.29, p<.001). We observed a negative relation between being Hispanic and being a victim (ES = -.10, p<.001) and a positive relation between being Black and being a bully (ES = .11, p<.001). We also observed statistically significant relations between a family's socioeconomic status and being a bully (ES = -.08, p<.001) as well as school poverty and being a victim (ES = .07, p<.001). The results advance the field's limited understanding of risk and protective factors for bullying perpetration or victimization during elementary school and provide additional empirical support for assisting young children already exhibiting externalizing problem behaviors.

Longitudinal Trajectories of Reading and Mathematics Achievement for Students With Learning Disabilities.

We examined to what extent subgroups of students identified with learning disabilities (LDs; N = 630) in the Early Childhood Longitudinal Study, Kindergarten Class of 1998 to 1999 (ECLS-K): 1998 national longitudinal study displayed heterogeneity in longitudinal profiles of reading and mathematics achievement from first to eighth grades. Multivariate growth mixture modeling yielded four classes of combined reading and mathematics trajectories for students with LD. The largest class of students with LD (Class 2, 54.3%) showed mean T-scores for both achievement domains that averaged about 1 SD below the mean, with modest decline over time. Almost a quarter of the sample (Class 1, 22.3%) displayed mean T-scores in both achievement areas near the peer-normed average; these students were mostly White, from higher socioeconomic status (SES) backgrounds, and had experienced earlier identification as having an LD as well as shorter duration of LD service. Classifying heterogeneity in longitudinal trajectories of both achievement areas shows promise to better understand the educational needs of students identified with an LD.

Which Students With Disabilities are Placed Primarily Outside of U.S. Elementary School General Education Classrooms?

Students with disabilities (SWD) who are Black or Hispanic have been reported to be more likely to be placed primarily outside of general education classrooms while attending U.S. schools. Federal law and regulation require monitoring of special education placement based on race or ethnicity. Yet, whether and to what extent racial or ethnic disparities in placement are explained by bias or by other explanatory factors is currently unclear. We evaluated for racial and ethnic bias in special education placement by analyzing longitudinal data from two independent samples of SWD (N values range 590-1,130) attending U.S. elementary schools. We statistically controlled for plausibly exogenous sociodemographic, academic, and behavioral risk factors measured in kindergarten in analyses of the students as they attended first, third, and fifth grades between the 1999-2000 and 2015-2016 school years. Of the resulting 12 Black or Hispanic grade-year-specific tests, 11 (i.e., 92%) indicated that controls for kindergarten explanatory factors-particularly significant academic difficulties-fully explained the risk initially attributable to race or ethnicity. We observed little evidence that bias explains racial or ethnic disparities in special education placement in U.S. elementary schools.

Which Children are Frequently Victimized in U.S. Elementary Schools? Population-based Estimates.

We analyzed a population-based cohort of 11,780 U.S. kindergarten children to identify risk and protective factors predictive of frequent verbal, social, reputational, and/or physical bullying victimization during the upper elementary grades. We also stratified the analyses by biological sex. Both girls and boys displaying kindergarten externalizing problem behaviors were at consistently higher risk of frequent victimization during 3rd-5th grade (for the combined sample of boys and girls, verbal odds ratio [OR] = 1.82, social OR = 1.60, reputational OR = 1.85, physical OR = 1.67, total OR = 1.93). Hispanic children relative to non-Hispanic White children and those from higher income families were the most strongly and consistently protected from victimization. Boys were more likely to be physically bullied but less likely to be verbally, socially or reputationally bullied than girls. Other variables including disability, cognitively stimulating parenting, academic achievement, and internalizing behavior problems had statistically significant but less consistent and generally weaker relations with frequent victimization.

Out-of-Pocket Medical Bills from First Childbirth and Subsequent Childbearing.

INTRODUCTION: Many families in the United States struggle to pay medical debt. This study aims to investigate the association between having out-of-pocket medical bills from first childbirth sent to debt collection agencies and subsequent childbearing. METHODS: As part of a large-scale birth cohort study (N = 2,169), women in Pennsylvania who delivered their first child in 2009 through 2011 were asked if any of the out-of-pocket medical expenditures resulting from the delivery were sent to debt collection agencies. Logistic regression models were used to assess the association between childbirth medical bills going to debt collections in the first year after delivery and subsequent childbearing over the following 2 years, controlling for relevant confounders, including maternal age, education, race/ethnicity, marital status, poverty level, insurance coverage, pregnancy intendedness, difficulty paying for basic needs, plans to have another child, pregnancy complications, and childbirth maternal and neonatal complications. RESULTS: Women received out-of-pocket medical bills for as much as $32,000. Overall, 8.3% reported having medical bills from the childbirth sent to debt collections. These women were substantially less likely to have a subsequent child during the follow-up period (22.4%) compared with their counterparts, whose medical bills did not go to collections (44.4%; adjusted odds ratio, 0.60; 95% confidence interval, 0.39-0.93). CONCLUSIONS: When out-of-pocket medical bills from first childbirth are more than American families can afford to pay, they may postpone having a second child. This finding may be particularly true when childbirth medical bills are sent to debt collection agencies.

Fertility counseling information adequacy as a moderator of regret among adolescent and young adult breast cancer survivors.

PURPOSE: Current literature disagrees on whether fertility counseling decreases or increases decision regret among young breast cancer survivors. This study investigates whether fertility counseling provided to pre-menopausal breast cancer patients regarding infertility due to treatment is associated with decision regret post-treatment, and how that relationship is moderated by information adequacy. METHODS: Breast cancer patients aged 18-35 listed in the Pennsylvania Cancer Registry as diagnosed between 2007 and 2012 were surveyed. Basic descriptive analyses were conducted, and linear regression models were estimated. RESULTS: Receipt of fertility counseling was not directly associated with decision regret. However, as fertility information adequacy increased, decision regret significantly decreased among women who received fertility counseling after finishing treatment or before and after finishing treatment. On average, a woman who receives fertility counseling before and after treatment with an information adequacy score of 1.5 had a regret score of 2.68. In contrast, a woman who received fertility counseling before and after treatment who had a fertility information adequacy score of 5 had a regret score of only 1.26 on average. CONCLUSION: Information adequacy is a significant moderator in the relationship between fertility counseling and decision regret. This suggests a possible explanation for disagreement in the literature regarding the benefits of fertility counseling and highlights the need for an increased focus on the adequacy of the information provided. IMPLICATIONS FOR CANCER SURVIVORS: Fertility counseling should be pursued for young adult breast cancer patients and survivors, provided that their satisfaction with the information received is monitored and remains high.

Association Between Mode of First Delivery and Subsequent Fecundity and Fertility.

Importance: More than 20% of births globally are by cesarean delivery, including more than 30% in the US. Prior studies have reported lower rates of childbearing after cesarean delivery, but it is not clear if this is due to maternal choice or lower conception rates. Objective: To investigate the association between mode of first delivery and subsequent conceptions and live births. Design, Setting, and Participants: The First Baby Study was a multicenter prospective cohort study of women aged 18 to 35 years with singleton pregnancies, enrolled and interviewed before first childbirth, who delivered in Pennsylvania from 2009 to 2011 and were followed up for 36 months after delivery (until April 2014). Data analysis for this study took place between May and July 2019 and in January 2020. Exposures: Mode of first delivery (cesarean or vaginal). Main Outcomes and Measures: Rates of subsequent conceptions and live births. Discrete-time Cox proportional hazard regression models were used to compare the rate of subsequent conception (vaginal vs cesarean) among those who completed the 36-month survey, accounting for reported months of unprotected intercourse during the follow-up period and adjusting for relevant covariates. A log binomial regression was used to compare the age-adjusted rate of subsequent live birth (vaginal vs cesarean) among those who completed the 36-month survey. Results: The study population consisted of 2423 women who were retained to the 36-month survey (mean [SD] age at baseline was 27.2 [4.4] years and 712 [29.4%] delivered by cesarean). There were 2046 women who had unprotected intercourse during the follow-up period, 2021 of whom provided data on months of unprotected intercourse. Cesarean delivery was associated with lower rates of conception after unprotected intercourse during the follow-up period (413 of 599 [68.9%]) compared with vaginal delivery (1090 of 1422 [76.7%]) (adjusted hazard ratio, 0.85; 95% CI, 0.74-0.96). Cesarean delivery was also associated with reduced likelihood of a subsequent live birth (305 women [42.8%]) compared with vaginal delivery (857 women [50.1%]), with an age-adjusted risk ratio of 0.83 (95% CI, 0.75-0.92). Conclusions and Relevance: In the 3 years following first childbirth, women who delivered their first child by cesarean had lower rates of conception after unprotected intercourse, and fewer of these women had a second child than those who delivered vaginally.

Reciprocal effects of reading and mathematics? Beyond the cross-lagged panel model.

Prior nonexperimental studies have been used to conclude that children's reading and mathematics achievement bidirectionally influence each other over time, with strong paths from (a) early reading to later mathematics and (b) early mathematics to later reading. In the most influential study on the topic, the early math-to-later-reading path was reported to be stronger than the early reading-to-later-math path (Duncan et al., 2007). Yet prior estimates may be confounded by stable environmental and personal factors influencing both reading and mathematics achievement. We reexamined the bidirectional relations between reading and mathematics achievement using both traditional models and extensions intended to account for unmeasured confounding. Results based on a large nationally representative sample of children from kindergarten to 3rd grade (N = 9,612) indicated that the estimated effects between reading and mathematics achievement differ substantially after accounting for the confounding effects of stable unmeasured factors. In these models, autoregressive and cross-lagged paths were substantially reduced. The finding that early mathematics predicts later reading more strongly than early reading predicts later math disappears and sometimes reverses, suggesting that larger paths from math to reading than from reading to math in previous related analyses are not causally informative. Stability in early mathematics and reading achievement resulted from substantially overlapping time invariant factors that correlate above .90. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Neighbourhood-level deprivation indices and postpartum women's health: results from the Community Child Health Network (CCHN) multi-site study.

BACKGROUND: Area-level socioeconomic characteristics have been shown to be related to health status and mortality however, little is known about the association between residential community characteristics in relation to postpartum women's health. METHODS: Data from the longitudinal, multi-site Community Child Health Network (CCHN) study were used. Postpartum women (n = 2510), aged 18-40 were recruited from 2008 to 2012 within a month of delivery. Socioeconomic data was used to create deprivation indices. Census data were analysed using principal components analysis (PCA) and logistic regression to assess the association between deprivation indices (DIs) and various health indicators. RESULTS: PCA resulted in two unique DIs that accounted for 67.5% of the total variance of the combined all-site area deprivation. The first DI was comprised of variables representing a high percentage of Hispanic or Latina, foreign-born individuals, dense households (more than one person per room of residence), with less than a high-school education, and who spent more than 30% of their income on housing costs. The second DI was comprised of a high percentage of African-Americans, single mothers, and high levels of unemployment. In a multivariate logistic regression model, using the quartiles of each DI, women who reside in the geographic area of Q4-Q2 of the second DI, were almost twice as likely to have more than three adverse health conditions compared to those who resided in the least deprived areas. (Q2vs.Q1:OR = 2.09,P = 0.001,Q3vs.Q1:OR = 1.89,P = 0.006,Q4vs.Q1:OR = 1.95,P = 0.004 respectively). CONCLUSIONS: Our results support the utility of examining deprivation indices as predictors of maternal postpartum health.

Beliefs about Using Smartphones for Health Behavior Change: An Elicitation Study with Overweight and Obese Rural Women.

BACKGROUND: Despite increased interest in developing mobile technology-based interventions, little research has examined preferences and beliefs about using smartphones for psychosocial or health behavior change interventions, particularly among women with overweight/obesity residing in rural communities. PURPOSE: The aims of this study were to examine the beliefs of pre- and interconceptional women about using smartphones and to examine the extent to which women's preferences for using smartphones changed as a result of participating in study interviews. METHODS: Forty women (M age = 28.2 years; M BMI = 31.4; 50% obese) participated in one-time 90 minute interviews and completed questionnaires before and after the interviews. Descriptive statistics were used to examine the frequency of women's preferences for using smartphones and applications. Interviews were downloaded and transcribed; principles of thematic analysis were used to code the interviews and identify themes. RESULTS: Women identified advantages of using smartphones for behavioral interventions, including being convenient, useful, and able to provide social support. Primary disadvantages were annoyances and needing technology support for phone problems. Participating in interviews also resulted in significant improvements in participant willingness to use smartphones in health behavior change interventions. DISCUSSION: The study findings highlight the importance of understanding beliefs about using smartphones before designing effective smartphone-based interventions, especially for use with pre- and interconceptional women with overweight/obesity who may have unique challenges with study adherence. These findings also suggest beliefs about smartphone utility can be improved over the course of a brief interview that taps into technology-related preferences. CONCLUSION: Identifying advantages/disadvantages of smartphone use can inform intervention design. Future research should explore how to capitalize on strategies that enable the benefits of technology (e.g., convenience, social support) while minimizing participant barriers (e.g., distractions) to promote behavior change and facilitate intervention compliance.

Are students with disabilities suspended more frequently than otherwise similar students without disabilities?

Students with disabilities (SWD) have been reported to be disproportionately suspended from U.S. schools and so more likely to experience the "school-to-prison pipeline" through suspension's associations with lower academic achievement, dropout, juvenile delinquency, and adult criminality. Yet few studies have estimated SWD's risk of more frequent suspension while simultaneously controlling for potential confounds. Negative binomial regression modeling of suspension count data from a nationally representative and longitudinal sample (N = 6,740) indicated that males, those from lower resourced families, and students attending more economically segregated schools were more frequently suspended. On average, students who are Black received about 1.6 times as many suspensions by the end of 8th grade as otherwise similar White students. In contrast, having a disability by 1st grade was not a risk factor for more frequent suspension by the end of 8th grade while simultaneously accounting for other risk factors (e.g., gender, race/ethnicity, family SES, prior history of externalizing problem behaviors, being from a English-speaking household, school-level economic composition). Students with specific disability conditions (e.g., emotional disturbances, speech or language impairments) were not at increased risk for more frequent suspension. Students with disabilities who are Black, Hispanic, or of other race/ethnicity were not more frequently suspended than SWD who are White.

Kindergarten Children's Executive Functions Predict Their Second-Grade Academic Achievement and Behavior.

Whether and to what extent kindergarten children's executive functions (EF) constitute promising targets of early intervention is currently unclear. This study examined whether kindergarten children's EF predicted their second-grade academic achievement and behavior. This was done using (a) a longitudinal and nationally representative sample (N = 8,920, Mage  = 97.6 months), (b) multiple measures of EF, academic achievement, and behavior, and (c) extensive statistical control including for domain-specific and domain-general lagged dependent variables. All three measures of EF-working memory, cognitive flexibility, and inhibitory control-positively and significantly predicted reading, mathematics, and science achievement. In addition, inhibitory control negatively predicted both externalizing and internalizing problem behaviors. Children's EF constitute promising targets of experimentally evaluated interventions for increasing academic and behavioral functioning.

Cardiovascular and Metabolic Risk in Women in the First Year Postpartum: Allostatic Load as a Function of Race, Ethnicity, and Poverty Status.

OBJECTIVE: Allostatic load (AL) represents multisystem physiological "wear-and-tear" reflecting emerging chronic disease risk. We assessed AL during the first year postpartum in a diverse community sample with known health disparities. STUDY DESIGN: The Eunice Kennedy Shriver National Institute for Child Health and Human Development Community Child Health Network enrolled 2,448 predominantly low-income African-American, Latina, and White women immediately after delivery of liveborn infants at ≥20 weeks' gestation, following them over time with interviews, clinical measures, and biomarkers. AL at 6 and 12 months postpartum was measured by body mass index, waist:hip ratio, blood pressure, pulse, hemoglobin A1c, high-sensitive C-reactive protein, total cholesterol and high-density lipoprotein, and diurnal cortisol slope. RESULTS: Adverse AL health-risk profiles were significantly more prevalent among African-American women compared with non-Hispanic Whites, with Latinas intermediate. Breastfeeding was protective, particularly for White women. Complications of pregnancy were associated with higher AL, and disparities persisted or worsened through the first year postpartum. CONCLUSION: Adverse AL profiles occurred in a substantial proportion of postpartum women, and disparities did not improve from birth to 1 year. Breastfeeding was protective for the mother.

Preconceptional health behavior change in women with overweight and obesity: prototype for SMART strong healthy women intervention.

BACKGROUND: The prevalence of maternal perinatal obesity is rising, and in turn, increases health risks and morbidity for both mother and child. Past evidence suggests the preconceptional Strong Healthy Women (SHW) intervention can reduce multiple biobehavioral risk factors for adverse perinatal health. The SHW intervention, however, was time- and resource-intensive to deliver. Mobile health (mHealth) technologies provide an opportunity to expand intervention reach while reducing implementation cost and burden. Previous research suggests that preconceptional women are broadly supportive of using smartphones for behavior change, yet few studies have elicited their specific preferences for a targeted mHealth intervention. The objective of this study was to evaluate women's preferences for receiving SHW content via smartphone to supplement the design of SMART SHW, a redeveloped version of the intervention that utilizes smartphones to enhance delivery. METHODS: Overweight/obese (mean BMI =31.4) preconceptional community women (N=40) participated in semi-structured focus group interviews. SHW components across four content areas (physical activity, nutrition, stress, weight management) were presented to participants; women provided preferences for program elements viewed as acceptable to convert to smartphone. Thematic analysis was used to analyze interview data. After the interviews were completed, an iterative review of the data to determine which aspects of SHW were feasible to modify for mobile delivery was conducted. RESULTS: Women preferred to receive SHW communications, surveys, and educational materials on their smartphones via texting, mobile websites, and a SMART SHW app; MyFitnessPal and a wearable pedometer were preferred methods for tracking nutrition and activity. Salient mHealth design themes included providing pop-ups as reminders, using web-based videos to supplement the curriculum, and presenting on-screen information in a concise format. In designing the final prototype, 87% of participant preferences were able to be incorporated. CONCLUSIONS: Smartphone devices can enhance the reach of face-to-face behavioral interventions by reducing implementation burden. Engaging end-users (in this case, preconceptional women with overweight/obesity) in the mHealth design process through semi-structured focus groups is a feasible and useful approach. Eliciting and leveraging user preferences guides the development of an intervention framework that is highly acceptable to the target participants.

The Effects of Hospital Characteristics on Delays in Breast Cancer Diagnosis in Appalachian Communities: A Population-Based Study.

PURPOSE: Despite being generally accepted that delays in diagnosing breast cancer are of prognostic and psychological concern, the influence of hospital characteristics on such delays remains poorly understood, especially in rural and underserved areas. However, hospital characteristics have been tied to greater efficiency and warrant further investigation as they may have implications for breast cancer care in these areas. METHODS: Study data were derived from the Kentucky, North Carolina, Ohio, and Pennsylvania state central cancer registries (2006-2008). We then linked Medicare enrollment files and claims data (2005-2009), the Area Resource File (2006-2008), and the American Hospital Association Annual Survey of Hospitals (2007) to create an integrated data set. Hierarchical linear modeling was used to regress the natural log of breast cancer diagnosis delay on a number of hospital-level, demographic, and clinical characteristics. FINDINGS: The baseline study sample consisted of 4,547 breast cancer patients enrolled in Medicare that lived in Appalachian counties at the time of diagnosis. We found that hospitals with for-profit ownership (P < .01) had shorter diagnosis delays than their counterparts. Estimates for comprehensive oncology services, system membership and size were not statistically significant at conventional levels. CONCLUSIONS: Some structural characteristics of hospitals (eg, for-profit ownership) in the Appalachian region are associated with having shorter delays in diagnosing breast cancer. Researchers and practitioners must go beyond examining patient-level demographic and tumor characteristics to better understand the drivers of timely cancer diagnosis, especially in rural and underserved areas.

Eight-Year Latent Class Trajectories of Academic and Social Functioning in Children with Attention-Deficit/Hyperactivity Disorder.

We examined trajectories of academic and social functioning in children with attention-deficit/hyperactivity disorder (ADHD) to identify those who might be at risk for especially severe levels of academic and social impairment over time. We estimated a series of growth mixture models using data from two subsamples of children participating in the NIMH Collaborative Multisite Multimodal Treatment Study of Children with ADHD (MTA) including those with at least baseline and 96-month data for reading and mathematics achievement (n = 392; 77.3% male; M age = 7.7; SD = 0.8) or social skills ratings from teachers (n = 259; 74.9% male; M age = 7.6; SD = 0.8). We compared latent trajectories for children with ADHD to mean observed trajectories obtained from a local normative (i.e., non-ADHD) comparison group (n = 289; 80.6% male; M age = 9.9; SD = 1.1). Results indicated six latent trajectory classes for reading and mathematics and four classes for teacher social skills ratings. There was not only a relationship between trajectories of inattention symptoms and academic impairment, but also a similarly strong association between trajectory classes of hyperactive-impulsive symptoms and achievement. Trajectory class membership correlated with socio-demographic and diagnostic characteristics, inattention and hyperactive-impulsive symptom trajectories, externalizing behavior in school, and treatment receipt and dosage. Although children with ADHD display substantial heterogeneity in their reading, math, and social skills growth trajectories, those with behavioral and socio-demographic disadvantages are especially likely to display severe levels of academic and social impairment over time. Evidence-based early screening and intervention that directly address academic and social impairments in elementary school-aged children with ADHD are warranted. The ClinicalTrials.gov identifier is NCT00000388.

Does Maternity Care Coordination Influence Perinatal Health Care Utilization? Evidence from North Carolina.

OBJECTIVE: To examine effects of maternity care coordination (MCC) on perinatal health care utilization among low-income women. DATA SOURCES: North Carolina Center for Health Statistics Baby Love files that include birth certificates, maternity care coordination records, WIC records, and Medicaid claims. STUDY DESIGN: Causal effects of MCC participation on health care outcomes were estimated in a sample of 7,124 singleton Medicaid-covered births using multiple linear regressions with inverse probability of treatment weighting (IPTW). PRINCIPAL FINDINGS: Maternity care coordination recipients were more likely to receive first-trimester prenatal care (p < .01) and averaged three more prenatal visits and two additional primary care visits during pregnancy; they were also more likely to participate in WIC and to receive postpartum family planning services (p < .01). Medicaid expenditures were greater among mothers receiving MCC. CONCLUSIONS: Maternity care coordination facilitates access to health care and supportive services among Medicaid-covered women. Increased maternal service utilization may increase expenditures in the short run; however, improved newborn health may reduce the need for costly neonatal care, and by implication the need for early intervention and other supports for at-risk children.

Immigrant Generational Status and Developmental Problems among Prematurely Born Children.

Immigrants in the U.S. often have comparatively favorable health outcomes despite relative socioeconomic disadvantage- a phenomenon termed the Immigrant Paradox. This study examined the relationship between family immigrant status and developmental problems among children born preterm. The 2011-2012 National Survey of Children's Health data collected through a telephone based survey based on parental report of prematurity and other comorbidities were analyzed using multivariate logistic regression analysis to examine seven developmental outcomes. Preterm 1st/2nd generation children had fewer developmental problems than preterm 3rd generation children. Controlling for socioeconomic status and other covariates, 1st/2nd generation children had significantly lower odds of developmental delay, cerebral palsy, epilepsy, and hearing problems. Consistent with the Immigrant Paradox, prematurely born children of immigrants had comparable or better developmental outcomes than preterm children of US born parents despite socioeconomic disadvantage. Further research to explicate mechanisms responsible for the protective health effects observed is warranted.

Executive Functioning Deficits Increase Kindergarten Children's Risk for Reading and Mathematics Difficulties in First Grade.

Whether executive functioning deficits result in children experiencing learning difficulties is presently unclear. Yet evidence for these hypothesized causal relations has many implications for early intervention design and delivery. We used a multi-year panel design, multiple criterion and predictor variable measures, extensive statistical control for potential confounds including autoregressive prior histories of both reading and mathematics difficulties, and additional epidemiological methods to preliminarily examine these hypothesized relations. Results from multivariate logistic regression analyses of a nationally representative and longitudinal sample of 18,080 children (i.e., the Early Childhood Longitudinal Study-Kindergarten Cohort of 2011, or ECLS-K: 2011) indicated that working memory and, separately, cognitive flexibility deficits uniquely increased kindergarten children's risk of experiencing reading as well as mathematics difficulties in first grade. The risks associated with working memory deficits were particularly strong. Experimentally-evaluated, multi-component interventions designed to help young children with reading or mathematics difficulties may also need to remediate early deficits in executive function, particularly in working memory.