The importance of community resources for breastfeeding.

BACKGROUND: Breastfeeding has long-lasting effects on children's cognition, behavioral, mental and physical health. Previous research shows parental characteristics (e.g., education, race/ethnicity, income level) are associated with breastfeeding initiation and duration. Further, research shows significant variation in access to community resources by race/ethnicity. It is unclear how community resources may impact breastfeeding practices and how this might intersect with maternal race/ethnicity. METHODS: This study combined nationally-representative data from the Study of Attitudes and Factors Effecting Infant Care (SAFE), which surveyed US mothers immediately after the infant's birth and at two to six months of infant age, with the Child Opportunity Index (COI) 2.0, a census tract measure of community resources associated with child development, to explore the association between community resources and breastfeeding initiation and whether this varies based on maternal race/ethnicity and country of birth. The SAFE Study used a stratified, two-stage, clustered design to obtain a nationally representative sample of mothers of infants, while oversampling Hispanic and non-Hispanic (NH) Black mothers. The SAFE study enrolled mothers who spoke English or Spanish across 32 US birth hospitals between January 2011 and March 2014. RESULTS: After accounting for individual characteristics, mothers residing in the highest-resourced communities (compared to the lowest) had significantly greater likelihood of breastfeeding. Representation in higher-resourced communities differed by race/ethnicity. Race/ethnicity did not significantly moderate the association between community resources and breastfeeding. In examining within race/ethnic groups, however, community resources were not associated with non-US born Black and Hispanic mothers' rates of breastfeeding, while they were with US born Black and Hispanic mothers. CONCLUSIONS: Findings suggest that even health behaviors like breastfeeding, which we often associate with individual choice, are connected to the community resources within which they are made. Study implications point to the importance of considering the impact of the contextual factors that shape health and as a potential contributor to understanding the observed race/ethnicity gap.

Maternal Education and Child Self-Regulation: Do Maternal Self-Regulation and Responsiveness Mediate the Association?

OBJECTIVE: To examine the mediating role of observed maternal responsiveness and maternal self-regulation on the association between maternal education and children's self-regulation. METHODS: English-speaking mother-child dyads (n = 189) were recruited from a previous study and were eligible if the child was kindergarten eligible at the start of the 2020 to 2021 or 2021 to 2022 school year. Key measures included: Difficulties in Emotion Regulation Scale-Short Form for maternal emotional self-regulation, Culturally Affirming and Responsive Experiences for maternal responsiveness, and the Head-Toes-Knees-Shoulders for child self-regulation. The association between years of maternal education and child self-regulation was examined with linear regression, and the mediation analyses utilized 4 subsequent steps examining their relations. These steps were checked through a series of linear regressions, and beta weights were used to describe associations. Each potential mediator was examined separately. RESULTS: Children of mothers with higher education had significantly higher self-regulation, slope of 1.3 (95% confidence interval 0.3, 2.4, P = 0.015, beta = 0.18). Further, mothers with higher education had significantly higher observed responsiveness. The beta-weight of 0.34 (P < 0.001) supported maternal responsiveness as a mediator. Finally, in the test for direct and indirect effects, observed maternal responsiveness explained 29% (95% confidence interval 3.3%, 115%) of the association between maternal education and child self-regulation. CONCLUSIONS: This study highlights a key mechanism related to children's self-regulation skills and the significant role of observed maternal responsiveness in explaining the association between maternal education and child self-regulation.

Maternal Informal Learning Experiences that Shape Parenting Practices.

Objective: Current understanding of the linkage between maternal education and parenting practices has largely been informed using a narrow definition of educational attainment-the highest level of education an individual has completed. However, the proximal processes that shape parenting, including informal learning experiences, are also important to understand. Less is known about the informal learning experiences that shape parenting decisions and practices. To this end, we conducted a qualitative inquiry about the informal learning experiences of mothers of children ages 3 to 4 years with the specific goal of understanding how maternal informal learning experiences shape parenting decisions and practices. Design: We conducted interviews with 53 mothers from across the United States who had previously participated in a randomized controlled trial (RCT) of an intervention targeting infant care practices. We recruited a purposive sample of mothers chosen to maximize diversity across educational attainment and adherence to infant care practices targeted in the RCT. Using a grounded theory approach, data were analyzed using an iterative process for organizing codes and themes that mothers identified as informal learning experiences. Results: We identified seven themes representing distinct types of maternal informal learning experiences that impact parenting practices, including: (1) experiential learning during childhood; (2) experiential learning during adulthood; (3) interpersonal interactions including via social media; (4) experiences with non-interactive media sources; (5) informal trainings; (6) beliefs; and (7) current circumstances. Conclusions: Multiple informal learning experiences inform the parenting decisions and practices of mothers with varying levels of formal educational attainment.

Do Neighborhood Resources Mitigate Family Risk to Preschool Children's Executive Function Skills Growth?

Despite previous studies showing that children's development of executive function (EF) skills is associated with the differing contexts in which children live, evidence about the independent and synergistic effects of families and neighborhoods is limited. Using a sample from a two-cohort longitudinal study of preschoolers from low-income families, we examined whether residential neighborhood resources (measured with the Child Opportunity Index (COI)) moderated the relationship between family cumulative risk and the growth trajectory of children's EF skills. Results from conditional growth curve models indicate family cumulative risk was negatively related to baseline EF skills and the rate of EF skill growth. In contrast, the overall COI and the COI social and economic domain z-score were positively associated with the initial, but not linear, growth of EF skills. We found no evidence of moderator effects. Policies that aim to better target and support the most vulnerable children should consider the unique contribution of family risks and neighborhood resources to child development.

The Role of Preschool Dosage and Quality in Children's Self-Regulation Development.

The present study examined how the dosage and quality of the federal preschool program "Head Start" (HS) in the US related to children's self-regulation skills in kindergarten. Using Propensity Score Matching and multiple regression (OLS), this study explored how the number of years and hours a week of HS were related to self-regulation among 2,383 children, who entered the program either at 3 or 4 years old. An additional year in HS was significantly positively associated with self-regulation in kindergarten, while the number of hours a week in HS was not. However, the quality of teacher-child interactions moderated the relation between hours a week in HS and self-regulation. Findings contribute to the growing body of evidence about how dosage and quality of early childhood education experiences relate to children's development.

Sleep Patterns and School Readiness of Pre-Kindergarteners from Racially and Ethnically Diverse, Low-Income Backgrounds.

OBJECTIVE: To explore patterns in parent-reported child sleep health and to investigate connections between such patterns and school readiness for newly enrolled prekindergarten (PreK) attendees from racially and ethnically diverse, low-income backgrounds. STUDY DESIGN: In a secondary analysis from a larger multiple-cohort longitudinal observational study of prekindergartners in low-income families, parental reports of sleep health for 351 children (mean age, 52.8 ± 3.5 months) during the first month of PreK were analyzed. Children also had completed direct assessments measuring language, literacy, mathematics, and executive functioning, and teachers rated children's social-emotional-behavioral competencies and approaches to learning at PreK entry. We performed latent class analyses to identify patterns in sleep health and used regression models to examine concurrent associations between child sleep health patterns and school readiness competencies across 6 domains: language, literacy, mathematics, executive functioning, social-emotional-behavioral, and approaches to learning. RESULTS: Two classes emerged reflecting more and less desirable patterns of sleep health. Children classified in the earlier, longer, consistent sleep health class (87% of children) experienced earlier bedtimes, longer night-time sleep durations, more consistent sleep routines, less caffeine consumption ≤3 hours before bedtime, and scored higher on a direct assessment of expressive vocabulary and on teacher-reported measures of social-emotional-behavioral competencies and learning approaches than their peers in the later, shorter, inconsistent sleep health class (13% of children). CONCLUSIONS: Consistent sleep routines and more optimal sleep health may serve as a protective mechanism for the language development, social-emotional-behavioral regulation, and approaches to learning of PreK from racially and ethnically diverse, low-income backgrounds. Clinician-parent discussions regarding optimal sleep health may provide key opportunities for targeted education that promotes school readiness skill development.

Investigating Mechanisms for Maternal Education Disparities in Enacting Health-Promoting Infant Care Practices.

BACKGROUND: Although higher education and healthier practices are positively associated, the explanatory mechanisms for this association remain unclear. The purpose of this study was to better understand mechanisms underlying this association by examining maternal adherence to 2 health-promoting infant care practices: supine placement and breastfeeding. METHODS: We analyzed nationally representative data from the Study of Attitudes and Factors Effecting Infant Care, which surveyed US mothers after infant birth and 2 months thereafter. Using the Theory of Planned Behavior as a framework, we used structural equation models to elucidate mediational pathways from maternal education to supine infant placement or any breastfeeding. RESULTS: Data from 3297 mothers demonstrated 77.0% of infants usually were placed supine, and 57.8% received any breastfeeding. The overall direct effect of maternal educational level on supine placement and any breastfeeding was odds ratio (OR) 1.31 (95% confidence interval [CI] 1.11-1.54) and OR 2.82 (95% CI 2.35-3.37), respectively. In pathway analyses, the strongest associations with both supine position and breastfeeding were seen with positive attitudes (supine: aOR 18.96, 95% CI 9.00-39.92; breastfeeding: aOR 3.86, 95% CI 2.19-6.82) and positive social norms (supine: aOR 6.69, 95% CI 4.52-9.89; breastfeeding: aOR 5.17, 95% CI 4.28-6.23). Mothers with more education had higher odds of both positive attitudes and positive norms for the 2 practices. CONCLUSIONS: The associations linking educational attainment with health practices are intricate, with multiple mediating pathways. Attitudes and social norms are powerful forces that mediate the association between maternal educational attainment and both infant supine positioning and breastfeeding, and may be important mediators for other health behaviors.

How Lifestyle Factors Affect Cognitive and Executive Function and the Ability to Learn in Children.

In today's research environment, children's diet, physical activity, and other lifestyle factors are commonly studied in the context of health, independent of their effect on cognition and learning. Moreover, there is little overlap between the two literatures, although it is reasonable to expect that the lifestyle factors explored in the health-focused research are intertwined with cognition and learning processes. This thematic review provides an overview of knowledge connecting the selected lifestyle factors of diet, physical activity, and sleep hygiene to children's cognition and learning. Research from studies of diet and nutrition, physical activity and fitness, sleep, and broader influences of cultural and socioeconomic factors related to health and learning, were summarized to offer examples of research that integrate lifestyle factors and cognition with learning. The literature review demonstrates that the associations and causal relationships between these factors are vastly understudied. As a result, current knowledge on predictors of optimal cognition and learning is incomplete, and likely lacks understanding of many critical facts and relationships, their interactions, and the nature of their relationships, such as there being mediating or confounding factors that could provide important knowledge to increase the efficacy of learning-focused interventions. This review provides information focused on studies in children. Although basic research in cells or animal studies are available and indicate a number of possible physiological pathways, inclusion of those data would distract from the fact that there is a significant gap in knowledge on lifestyle factors and optimal learning in children. In a climate where childcare and school feeding policies are continuously discussed, this thematic review aims to provide an impulse for discussion and a call for more holistic approaches to support child development.

Changing Teacher-Child Dyadic Interactions to Improve Preschool Children's Externalizing Behaviors.

A randomized controlled trial was used to examine the impact of an attachment-based, teacher-child, dyadic intervention (Banking Time) to improve children's externalizing behavior. Participants included 183 teachers and 470 preschool children (3-4 years of age). Classrooms were randomly assigned to Banking Time, child time, or business as usual (BAU). Sparse evidence was found for main effects on child behavior. Teachers in Banking Time demonstrated lower negativity and fewer positive interactions with children compared to BAU teachers at post assessment. The impacts of Banking Time and child time on reductions of parent- and teacher-reported externalizing behavior were greater when teachers evidenced higher-quality, classroom-level, teacher-child interactions at baseline. An opposite moderating effect was found for children's positive engagement with teachers.

Visuomotor integration and inhibitory control compensate for each other in school readiness.

Visuomotor integration (VMI), or the ability to copy designs, and 2 measures of executive function were examined in a predominantly low-income, typically developing sample of children (n = 467, mean age 4.2 years) from 5 U.S. states. In regression models controlling for age and demographic variables, we tested the interaction between visuomotor integration (design copying) and inhibitory control (pencil-tap) or verbal working memory (digit span) on 4 directly assessed academic skills and teacher-reported approaches to learning. Compared with children with both poor visuomotor integration and low inhibitory control, those on the higher end of the continuum in at least 1 of these 2 skills performed better across several dependent variables. This compensatory pattern was evident for longitudinal improvement in print knowledge on the Test of Preschool Early Literacy (TOPEL), with similar though marginally significant findings for improvement in phonological awareness (TOPEL) and teacher-rated approaches to learning on the Preschool Learning Behaviors Scale (PLBS). Of note, the same compensatory pattern emerged for concurrently measured receptive vocabulary on the Peabody Picture Vocabulary Test (PPVT), expressive vocabulary on the Woodcock-Johnson III (WJ), TOPEL phonological awareness, and teacher-rated approaches to learning. The consistent pattern of results suggests that strong visuomotor integration skills are an important part of school readiness, and merit further study.

Program and Teacher Characteristics Predicting the Implementation of Banking Time with Preschoolers Who Display Disruptive Behaviors.

This study examined the relationship among baseline program and teacher characteristics and subsequent implementation of Banking Time. Banking Time is a dyadic intervention intended to improve a teacher's interaction quality with a specific child. Banking Time implementation was examined in the current study using a sample of 59 teachers and preschool children displaying disruptive behaviors in the classroom (~three children per classroom). Predictors included preschool program type, teacher demographic characteristics (personal and professional), and teacher beliefs (self-efficacy, authoritarian beliefs, and negative attributions about child disruptive behavior). Multiple measures and methods (i.e., teacher report, consultant report, independent observations) were used to assess implementation. We created three implementation composite measures (dosage, quality, and generalized practice) that had high internal consistencies within each composite but were only modestly associated with one another, suggesting unique constructs of implementation. We found that type of preschool program was associated with dosage and quality. Aspects of teacher demographics related to all three implementation composites. Teacher beliefs predicted dosage and generalized practice. Results suggest that the factors that predict the implementation of Banking Time vary as a function of the type of implementation being assessed.

Individual and Contextual Factors Associated with Pre-Kindergarten Teachers' Responsiveness to the MyTeachingPartner Coaching Intervention.

With research findings indicating positive associations between teacher-child interaction quality and children's development and learning, many professional development efforts now focus on improving the ways in which teachers interact with children. Previous work found that MyTeachingPartner (MTP), a web-mediated coaching intervention, improved teachers' classroom interactions with children, and further analysis found that improvement in teachers' interactions was mediated by their responsiveness to the MTP intervention. The current study assessed how teacher characteristics, including demographics, beliefs, and psychological factors, as well as contextual characteristics related to multiple measures of teachers' responsiveness to MTP. Findings show that related factors vary across the different indicators of responsiveness. Specifically, the psychological factors of anxiety and readiness to change related to multiple indicators of responsiveness. Further, readiness to change and self-efficacious beliefs moderated the associations between classroom poverty and responsiveness. Study findings provide new insights into key teacher characteristics that might identify teachers in need of intervention adaptation or support to ultimately increase overall responsiveness.

The Role of the Mentor in Supporting New Teachers: Associations with Self-Efficacy, Reflection, and Quality.

In our study, we examined variation in mentoring aspects of an induction program for 77 novice teachers and associations with self-efficacy, reflection, and quality of student-teacher interactions. Mentors' previous experience and full- vs. part-time status predicted novices' perception of support, reflection, and observed student-teacher interactions. Time spent with a mentor, participation in mentor-facilitated professional development activities and the quality of mentors' interactions with novice teachers were related to novice teachers' perceptions of mentoring success, self-reflection, and efficacy. The data in our study add to the growing research suggesting the need to look within the mentoring experience to more fully understand the working mechanisms and important contributors to their success.

Long-term cognition, achievement, socioemotional, and behavioral development of healthy late-preterm infants.

OBJECTIVE: To compare healthy late-preterm infants with their full-term counterparts from age 4 through 15 years for numerous standard cognitive, achievement, socioemotional, and behavioral outcomes. DESIGN: Prospective cohort study. SETTING: National Institute of Child Health and Development Study of Early Child Care and Youth Development, 1991-2007. PARTICIPANTS: A total of 1298 children (53 born at 34-36 weeks' gestational age), and their families, observed from birth through age 15 years. None of the infants had major health problems before or immediately following birth, and all the infants were discharged from the hospital within 7 days. MAIN EXPOSURE: Preterm status: children born late preterm (34-36 weeks) vs those born full term (37-41 weeks). MAIN OUTCOME MEASURES: Eleven standard outcomes measuring cognition, achievement, social skills, and behavioral/emotional problems using the Woodcock-Johnson Psycho-Educational Battery-Revised and the Child Behavior Checklist, administered repeatedly through age 15 years. RESULTS: No consistent significant differences were found between late-preterm and full-term children for these standard measures from ages 4 to 15 years. Through age 15 years, the mean difference of most of these outcomes hovered around 0, indicating, along with small confidence intervals around these differences, that it is unlikely that healthy late-preterm infants are at any meaningful disadvantage regarding these measures. CONCLUSION: Late-preterm infants born otherwise healthy seem to have no real burdens regarding cognition, achievement, behavior, and socioemotional development throughout childhood.

Teacher Characteristics Associated with Responsiveness and Exposure to Consultation and On-line Professional Development Resources.

This paper is a natural follow-up to intent-to-treat findings indicating that the MyTeachingPartner Consultancy, inclusive of on-line video resources and web-mediated consultation, improved the quality of pre-k teachers' interactions with children. This study takes a close look at implementation fidelity within the effective MTP Consultancy condition over both years of implementation, in order to learn more about the ingredients of professional development that may have contributed to the success of the intervention. Variation in teachers' responsiveness (e.g., ratings of Consultancy worth) and exposure to the intervention (e.g., number of consultation cycles completed) are examined, with particular interest in the identification of teacher factors that may serve as supports or barriers to successfully implementing consultation supports and on-line professional development resources.

Transition from pediatric to adult medical care.

Because of recent medical advances, the number of children with chronic medical conditions who survive into adulthood has increased. The transition of care from pediatric to adult specialists and subspecialists has been rarely studied, yet it is an important aspect of care. To define issues in the pediatric patients at the University of Virginia, survey data was collected from adult nephrologists in the state. A total of 105 surveys were mailed to adult providers in Virginia. From 62 responses, 60% of adult providers did not feel completely comfortable caring for a patient with a pediatric-specific diagnosis. To efficiently receive information on new patients, adult providers preferred an abbreviated medical summary or phone call from pediatric providers. Additionally, interviews were conducted with 6 pediatric patients and their families. Patients reported a good grasp of their diagnosis and treatment, expressed an interest in learning chronic-illness coping strategies, and expressed interest in obtaining community-resource information. This study reiterated the need for additional insurance options for this at-risk population. Development of individualized transition plans and transition services are recommended to support young adult patients with chronic medical conditions as they transition into adulthood.