Corrigendum: Systematic review on fiscal policy interventions in nutrition.

[This corrects the article DOI: 10.3389/fnut.2022.967494.].

Effective interventions for improving routine childhood immunisation in low and middle-income countries: a systematic review of systematic reviews.

OBJECTIVE: An umbrella review providing a comprehensive synthesis of the interventions that are effective in providing routine immunisation outcomes for children in low and middle-income countries (L&MICs). DESIGN: A systematic review of systematic reviews, or an umbrella review. DATA SOURCES: We comprehensively searched 11 academic databases and 23 grey literature sources. The search was adopted from an evidence gap map on routine child immunisation sector in L&MICs, which was done on 5 May 2020. We updated the search in October 2021. ELIGIBILITY CRITERIA: We included systematic reviews assessing the effectiveness of any intervention on routine childhood immunisation outcomes in L&MICs. DATA EXTRACTION AND SYNTHESIS: Search results were screened by two reviewers independently applying predefined inclusion and exclusion criteria. Data were extracted by two researchers independently. The Specialist Unit for Review Evidence checklist was used to assess review quality. A mixed-methods synthesis was employed focusing on meta-analytical and narrative elements to accommodate both the quantitative and qualitative information available from the included reviews. RESULTS: 62 systematic reviews are included in this umbrella review. We find caregiver-oriented interventions have large positive and statistically significant effects, especially those focusing on short-term sensitisation and education campaigns as well as written messages to caregivers. For health system-oriented interventions the evidence base is thin and derived from narrative synthesis suggesting positive effects for home visits, mixed effects for pay-for-performance schemes and inconclusive effects for contracting out services to non-governmental providers. For all other interventions under this category, the evidence is either limited or not available. For community-oriented interventions, a recent high-quality mixed-methods review suggests positive but small effects. Overall, the evidence base is highly heterogenous in terms of scope, intervention types and outcomes. CONCLUSION: Interventions oriented towards caregivers and communities are effective in improving routine child immunisation outcomes. The evidence base on health system-oriented interventions is scant not allowing us to reach firm conclusions, except for home visits. Large evidence gaps exist and need to be addressed. For example, more high-quality evidence is needed for specific caregiver-oriented interventions (eg, monetary incentives) as well as health system-oriented (eg, health workers and data systems) and community-oriented interventions. We also need to better understand complementarity of different intervention types.

The impact of a music enrichment program during infancy and early toddlerhood on effortful control at age 3: A preliminary investigation.

Effortful control (EC), a self-regulation skill, is associated with long-term developmental outcomes. Music has been associated with infant self-regulation and may be an intervention strategy for enhancing EC during toddlerhood. This investigation included 32 parent-child dyads from a previously conducted randomized controlled trial (RCT). Participants (9-15-months old at baseline) attended either a music enrichment program or a playdate control once a week for 1 year and monthly for an additional year. At age 3, participants completed snack and gift delay effortful control tasks. Groups were compared using one-way ANOVA. We found that participants in the music group had a significantly higher score during snack delay (music mean = 3.47 ± 0.94; control mean = 2.45 ± 1.51; p = 0.03; Cohen's d = 0.84). We did not find a significant group difference for latency to peek (music mean = 39.10 ± 20.10; control mean = 30.90 ± 19.88; p = 0.25; d = 0.57) or latency to touch (music mean = 105.73 ± 417.69; control mean = 98.35 ± 28.84; p = 0.38; d = 0.29) for the gift task. This study provides initial evidence that early participation in a music enrichment program may benefit later development of EC. This study is registered at ClinicalTrials.gov (NCT02936284).

PROTOCOL: The effects of agricultural output market access interventions on agricultural, socio-economic and food and nutrition security outcomes in low- and middle-income countries: A systematic review.

Development agencies and international donors' efforts are increasingly focusing on better integrating poor and remote farmers into agricultural markets to address the chronic issues of rural poverty and hunger in low- and middle-income countries. Using systematic methods for information retrieval, critical appraisal and evidence synthesis, this research aims to examine evidence on the effects of five focal types of agricultural market access interventions: (i) farm-to-market transport infrastructure interventions; (ii) output market information interventions; (iii) initiatives creating new marketplaces and alternative marketing opportunities; (iv) contract farming initiatives; (v) interventions improving storage infrastructure. In this review, we will study evidence of the magnitude and direction of intervention effects on agricultural, socio-economic, and food and nutrition security outcomes. We will examine evidence of the distribution of reported effects across different contexts, interventions and sub-groups of the population (e.g., according to sex, socio-economic status, farm size, etc.). We will also report on included studies' risk of bias and on what evidence is available on intervention costs, or their cost-effectiveness. This protocol outlines this review's planned methods and the criteria for selecting and including studies in its analysis.

The effects of a music enrichment program on parent-infant interactions during mealtime: A randomized controlled trial.

BACKGROUND: Parent-child interactions are linked to childhood obesity. Music enrichment programs enhance parent-child interactions and may be a strategy for early childhood obesity prevention. OBJECTIVE: We implemented a 2-year randomized, controlled trial to assess the effects of a music enrichment program (music, n = 45) vs. active play date control (control, n = 45) on parent-child interactional quality and infant weight status. METHODS: Typically developing infants aged 9-to 15-months were enrolled with a primary caregiver in the Music Together ® or a play date program. Participants attended once per week group meetings for 12 months and once per month group meetings for an additional 12 months. Parent-child interaction was measured using the Parent Child Early Relational Assessment (PCERA) at baseline, month 6, 12, and 24. We used a modified intent-to-treat mixed model regression to test group differences in parent-child interactions and Weight for length z-score (zWFL) growth trajectories were modeled. RESULTS: There were significant differential group changes across time for negative affect during feeding (group*month; p = 0.02) in that those parents in the music group significantly decreased their negative affect score compared with the control group from baseline to month 12 (music change = -0.279 ± 0.129; control change = +0.254 ± 0.131.; p = 0.00). Additionally, we also observed significant differential group changes across time for parent intrusiveness during feeding (group*month; p = 0.04) in that those parents in the music group significantly decreased their intrusiveness score compared with the control group from month 6 to month 12 (music change = -0.209 ± 0.121; control change = 0.326 ± 0.141; p = 0.01). We did not find a significant association between any of the changes in parental negative affect and intrusiveness with child zWFL trajectories. CONCLUSION: Participating in a music enrichment program from an early age may promote positive parent-child interactions during feeding, although this improvement in the quality of parent-child interactions during feeding was not associated with weight gain trajectories.

Prenatal tobacco and cannabis co-exposure and offspring obesity development from birth to mid-childhood.

BACKGROUND: Although the association between prenatal tobacco exposure and child obesity risk is well-established, less is known about co-exposure to tobacco and cannabis. OBJECTIVE: Determine the relation between prenatal substance co-exposure and obesity risk. METHODS: In a diverse sample of pregnant women, we examined the association between prenatal substance exposure (tobacco-only and co-exposure) and child BMI (kg/m2 ) trajectories from birth to mid-childhood (n = 262), overweight/obese status based on BMI percentiles from toddlerhood (24 months) to mid-childhood (9-12 years), and adiposity outcomes at mid-childhood (fat mass [kg], fat mass [%] and fat free mass [kg]; n = 128). Given that the major goal of this study was to examine the associations between prenatal substance exposure and child outcomes, we oversampled pregnant women for substance use (with tobacco as the primary focus). RESULTS: Multilevel models demonstrated that children in both exposure groups had a steeper increase in BMI trajectory from birth to mid-childhood and among co-exposed children, girls had a steeper increase than boys. Odds ratio of having obesity by mid-childhood was 12 times higher among those co-exposed than non-exposed. Co-exposure led to significantly greater fat mass and fat mass % compared with no exposure, but exposure to only tobacco was no different than no exposure. CONCLUSIONS: Results highlight potentiating effects of cannabis exposure in the context of maternal tobacco use in pregnancy on obesity risk and the importance of multi-method assessments of obesity.

Systematic review on fiscal policy interventions in nutrition.

Introduction: Both the World Health Organization and the Lancet Series on Adolescent nutrition recommend that governments adopt fiscal policies to combat diet-related non-communicable diseases (NCDs). However, rigorous, systematic evidence regarding the effects of these interventions is lacking. Methods: We synthesize the available evidence regarding the impacts of taxes and subsidies that directly affect consumer prices on availability and accessibility of foods and beverages, purchasing behavior, diet quality, health and well-being outcomes as well as considerations for implementation, sustainability and equity. Results: Our initial search returned 2,113 de-duplicated studies, and ultimately 24 impact evaluations and two systematic reviews met final eligibility criteria and represented unique evaluations. Our meta-analysis of these studies suggests that taxes may decrease purchases of taxed beverages (SMD = -0.14 [95% CI: -0.29 to -0.07], n = 15). Results should be interpreted cautiously due to considerable heterogeneity (Q(14) = 335.19, p = 0.01, τ ^ 2 = 0.03 , I 2 = 95.82%). Discussion: The evidence base is too limited to draw conclusions about the effects of taxes on beverages and calorie-dense foods on purchases, or on the effects of subsidies on purchasing or diet quality. Overall, the evidence base is inconclusive on whether fiscal policies can meaningfully influence the availability and accessibility of foods and beverages, diet quality, and health outcomes. Policymakers implementing fiscal policies should consider information campaigns on health benefits and health risks associated with certain food and beverage consumption. For taxes, exposure to health information may amplify signaling effects of taxes and reduce avoidance behaviors, such as cross-border shopping. Future evaluations should diversify data sources to better understand impacts on diet and health outcomes.

Use of community engagement interventions to improve child immunisation in low-income and middle-income countries: a systematic review and meta-analysis.

OBJECTIVE: To support evidence informed decision-making, we systematically examine the effectiveness and cost-effectiveness of community engagement interventions on routine childhood immunisation outcomes in low-income and middle-income countries (LMICs) and identify contextual, design and implementation features associated with effectiveness. DESIGN: Mixed-methods systematic review and meta-analysis. DATA SOURCES: 21 databases of academic and grey literature and 12 additional websites were searched in May 2019 and May 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included experimental and quasi-experimental impact evaluations of community engagement interventions considering outcomes related to routine child immunisation in LMICs. No language, publication type, or date restrictions were imposed. DATA EXTRACTION AND SYNTHESIS: Two independent researchers extracted summary data from published reports and appraised quantitative risk of bias using adapted Cochrane tools. Random effects meta-analysis was used to examine effects on the primary outcome, full immunisation coverage. RESULTS: Our search identified over 43 000 studies and 61 were eligible for analysis. The average pooled effect of community engagement interventions on full immunisation coverage was standardised mean difference 0.14 (95% CI 0.06 to 0.23, I2=94.46). The most common source of risk to the quality of evidence (risk of bias) was outcome reporting bias: most studies used caregiver-reported measures of vaccinations received by a child in the absence or incompleteness of immunisation cards. Reasons consistently cited for intervention success include appropriate intervention design, including building in community engagement features; addressing common contextual barriers of immunisation and leveraging facilitators; and accounting for existing implementation constraints. The median intervention cost per treated child per vaccine dose (excluding the cost of vaccines) to increase absolute immunisation coverage by one percent was US$3.68. CONCLUSION: Community engagement interventions are successful in improving outcomes related to routine child immunisation. The findings are robust to exclusion of studies assessed as high risk of bias.

Within-person decline in pregnancy smoking is observable prior to pregnancy awareness: Evidence across two independent observational cohorts.

Decreased consumption of nicotine and other drugs during pregnancy appears to be a cross-species phenomenon from which mechanism(s) capable of interrupting addictive processes could be elucidated. Whether pregnancy influences smoking behaviour independent of women's knowledge of the pregnancy, however, has not been considered. Using repeated measures analysis of variance (ANOVA), we estimated within-person change in mean cigarettes/day smoked across the estimated date of conception but prior to individually reported dates of pregnancy recognition using longitudinal smoking data from two independent observational cohorts, the Growing Up Healthy (GUH, n = 271) and Midwest Infant Development Studies (MIDS, n = 145). Participants smoked an average of half a pack/day in the month immediately before conception (M (SD) = 12(8.1) and 9.5(6.7) cigarettes/day in GUH and MIDS, respectively). We observed within-person declines in smoking after conception, both before (MGUH  = -0.9; 95% CI -1.6, -0.2; p = 0.01; MMIDS  = -1.1; 95% CI -1.9, -0.3; p = 0.01) and after (MGUH  = -4.8; 95% CI -5.5, -4.1; p < 0.001; MMIDS  = -3.3; 95% CI -4.4, -2.5; p < 0.001) women were aware of having conceived, even when women who had quit and women who were planning to conceive were excluded from analyses. Pregnancy may interrupt smoking-related processes via mechanisms not previously considered. Plausible candidates and directions for future research are discussed.

Development of Bullying and Victimization: An Examination of Risk and Protective Factors in a High-Risk Sample.

This prospective longitudinal study from birth to late adolescence investigated how early risk predicted subsequent aggression in middle childhood and bullying perpetration, bullying victimization, and violence victimization in adolescence. In addition, the moderating role of protective factors (i.e., maternal sensitivity, positive peers, and school connectedness) on these associations were examined. Caregiver-infant dyads (N = 216; 72% Black/African American) were recruited as part of a longitudinal study on substance exposed youth. Data using multiple methods and informants (observations, interviews, caregiver, and child/youth self-reports) were collected from dyads in early childhood (EC, birth to 48 months), middle childhood (MC, i.e., 84 months), early adolescence (EA, M = 13.26 years, SD = .83) and later adolescence (LA, M = 15.08 years, SD = .83). A developmental cascading path model was tested. There were direct associations between EC maternal harsh parenting and aggression in MC. In turn, MC aggression was associated with higher violence victimization and bullying in EA. Finally, EA violence victimization was then associated with higher levels of bullying as well as victimization from bullying in LA. Consistent with predictions, there was also evidence that protective factors (i.e., maternal sensitivity and positive peers) moderated the impact of predictor variables on aggression and bullying outcomes. Specifically, maternal sensitivity moderated the link between EC and MC aggression, such that those with moderately high levels of maternal sensitivity showed a negative relation between EC and MC aggression, whereas those with low levels of maternal sensitivity showed continuity in aggression. Positive peer influence moderated the link between violence victimization in EA and bullying in LA, such that children high on both violence victimization and positive peers had the highest levels of bullying victimization.

Examining the Relationship between Infant Weight Status and Parent-Infant Interactions within a Food and Nonfood Context.

Background: Most observational research examining factors in the home environment that contribute to child adiposity has focused on feeding and physical activity, although aspects of one's nonfood home environment such as parent-child interactions can also impact body weight. The main objectives of this study were to determine if parent-infant interactions under different contexts provide a unique contribution to infants' concurrent adiposity after accounting for known obesity-related covariates. Methods: This was a cross-sectional analysis of 121 9- to 15-month-old infants using data collected at the baseline visit of an ongoing intervention study. Mother-infant interactions during a feeding episode and a free-play task were recorded and coded. Anthropometrics of infants were measured by trained research staff. We used two-step hierarchical multivariable regression models to examine the unique contribution of mother-infant interactions to weight status after accounting for known obesity-related covariates (i.e., maternal age, BMI, education, parity, and gestational age, child sex, breastfeeding duration, age of solid food introduction, and birthweight). Results: Maternal intrusiveness, child negative affect, and child responsiveness during free-play, but not feeding were significantly associated with z-weight-for-length. For every 1-U increase in maternal intrusiveness and child negative affect there was a 0.321 (p = 0.011) and 0.415 (p = 0.028) unit increase in z-weight-for-length, respectively, whereas for every 1-U increase in child responsiveness there was a decrease of 0.386 U in z-weight-for-length (p = 0.025). Conclusion: This research contributes new findings support the idea that parent-child interactions outside of the feeding context may relate to obesity. Clinical Trial Registration Number NCT02936284.

Child Community Violence Exposure in an at-Risk Sample: Developmental Trajectories, Caregiving Risks, and the Role of Child Temperament.

Objective: To better understand early etiological pathways to trajectories of child exposure to community violence (CECV), we used person-centered latent class growth analysis (LCGA) to examine chronicity of CECV from early school age through early adolescence, and examined early risks of the identified CECV trajectories (i.e., prenatal cocaine exposure, harsh parenting and caregiving instability across infancy and early childhood, and child activity level and inhibitory control at kindergarten age). Method: An at-risk sample (N = 216; 110 girls) of primarily low-income participants (76% on Temporary Assistance for Needy Families) with high rates of prenatal substance exposure was used. The majority of the mothers were African American (72%), had high school or below education (70%), and were single (86%). Postnatal assessments occurred at eight time points during infancy and toddlerhood, early childhood through early school age, and early adolescence. Results: We identified two distinct linearly increasing CECV trajectories (high-exposure and low-exposure). An interaction between child activity level and maternal harshness emerged, such that children with high activity levels and experiencing high harshness had the highest probabilities of being in the high exposure-increasing trajectory, in addition to early caregiving instability (conditional effect). Conclusion: The current findings not only have important theoretical implications but also provide insights into early intervention.

Strengthening women's empowerment and gender equality in fragile contexts towards peaceful and inclusive societies: A systematic review and meta-analysis.

Background: Across the globe, gender disparities still exist with regard to equitable access to resources, participation in decision-making processes, and gender and sexual-based violence. This is particularly true in fragile and conflict-affected settings, where women and girls are affected by both fragility and conflict in unique ways. While women have been acknowledged as key actors in peace processes and post-conflict reconstruction (e.g., through the United Nations Security Council Resolution 1325 and the Women, Peace and Security Agenda) evidence on the effectiveness of gender-specific and gender-transformative interventions to improve women's empowerment in fragile and conflict-affected states and situations (FCAS) remains understudied. Objectives: The purpose of this review was to synthesize the body of evidence around gender-specific and gender-transformative interventions aimed at improving women's empowerment in fragile and conflict-affected settings with high levels of gender inequality. We also aimed to identify barriers and facilitators that could affect the effectiveness of these interventions and to provide implications for policy, practice and research designs within the field of transitional aid. Methods: We searched for and screened over 100,000 experimental and quasi-experimental studies focused on FCAS at the individual and community levels. We used standard methodological procedures outlined by the Campbell Collaboration for the data collection and analysis, including quantitative and qualitative analyses, and completed the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology to assess the certainty around each body of evidence. Results: We identified 104 impact evaluations (75% randomised controlled trials) assessing the effects of 14 different types of interventions in FCAS. About 28% of included studies were assessed as having a high risk of bias (45% among quasi-experimental designs). Interventions supporting women's empowerment and gender equality in FCAS produced positive effects on the outcomes related to the primary focus of the intervention. There are no significant negative effects of any included interventions. However, we observe smaller effects on behavioural outcomes further along the causal chain of empowerment. Qualitative syntheses indicated that gender norms and practices are potential barriers to intervention effectiveness, while working with local powers and institutions can facilitate the uptake and legitimacy of interventions. Conclusions: We observe gaps of rigorous evidence in certain regions (notably MENA and Latin America) and in interventions specifically targeting women as actors of peacebuilding. Gender norms and practices are important elements to consider in programme design and implementation to maximise potential benefits: focusing on empowerment only might not be enough in the absence of targeting the restrictive gender norms and practices that may undermine intervention effectiveness. Lastly, programme designers and implementation should consider explicitly targeting specific empowerment outcomes, promoting social capital and exchange, and tailoring the intervention components to the desired empowerment-related outcomes.

Use of community engagement interventions to improve child immunisation in low- and middle-income countries: A systematic review and meta-analysis.

Immunisation is one of the most cost-effective interventions to prevent and control life-threatening infectious diseases. Nonetheless, rates of routine vaccination of children in low- and middle-income countries (LMICs) are strikingly low or stagnant. In 2019, an estimated 19.7 million infants did not receive routine immunisations. Community engagement interventions are increasingly being emphasised in international and national policy frameworks as a means to improve immunisation coverage and reach marginalised communities. This systematic review examines the effectiveness and cost-effectiveness of community engagement interventions on outcomes related to childhood immunisation in LMICs and identifies contextual, design and implementation features that may be associated with effectiveness. We identified 61 quantitative and mixed methods impact evaluations and 47 associated qualitative studies related to community engagement interventions for inclusion in the reteview. For cost-effectiveness analysis 14 of the 61 studies had the needed combination of cost and effectiveness data. The 61 included impact evaluations were concentrated in South Asia and Sub-Saharan Africa and spread across 19 LMICs. The review found that community engagement interventions had a small but significant, positive effect on all primary immunisation outcomes related to coverage and their timeliness. The findings are robust to exclusion of studies assessed as high risk of bias. Qualitative evidence indicates appropriate intervention design, including building in community engagement features; addressing common contextual barriers of immunisation and leveraging facilitators; and accounting for existing implementation constraints and practicalities on the ground are consistently cited as reasons for intervention success. Among the studies for which we were able to calculate cost-effectiveness, we find that the median non-vaccine cost per dose of intervention to increase immunisation coverage by 1% was US $3.68. Given the broad scope of the review in terms of interventions and outcomes, there is significant variation in findings. Among the various types of community engagement interventions, those that involve creation of community buy-in or development of new cadres of community-based structures were found to have consistent positive effect on more primary vaccination coverage outcomes than if the engagement is limited to the design or delivery of an intervention or is a combination of the various types. The evidence base for sub-group analysis for female children was sparse (only two studies) and the effect on coverage of both full immunisation and third dose of diphtheria pertussis tetanus for this group was insignificant.

Within- and between-family transactions of maternal depression and child engagement in the first 2 years of life: Role of prenatal maternal risk and tobacco use.

BACKGROUND: This study examined transactional associations among maternal depression, maternal sensitivity, and child engagement in the context of a low-income, diverse sample with maternal cigarette smoking during pregnancy (MSDP) as a moderator of these transactions. METHODS: A random-intercept cross-lagged panel model was used to investigate within- and between-family variability from infancy to toddlerhood. The sample included 247 mother-child dyads (47% girls; 51% African-American; 178 MSDP, 69 non-MSDP). Assessments were conducted once during each trimester of pregnancy and at 2, 9, 16, and 24 months of child ages. RESULTS: Between-family associations revealed that children exposed to higher levels of sensitive parenting across time had higher behavioral engagement from infancy to toddlerhood. At the within-family level, increased sensitive parenting at 9 months was predictive of increased child engagement at 16 months which in turn predicted increases in sensitive parenting at 24 months. Increased maternal depression was concurrently associated with lower maternal sensitivity at 2 months and lower child engagement at 16 months. Contrary to hypotheses, changes in maternal depression were not associated to changes in parenting or child engagement. These associations did not vary between prenatally smoking and nonsmoking mothers. However, there was significantly higher stability in maternal depression across time among nonsmoking mothers compared to those in the MSDP group. Additionally, increased maternal depression was related to lower-than-expected child engagement at 9 months only for the nonsmoking group. CONCLUSIONS: Results highlight transactional processes at the within-family level and the importance of timing for parent and child effects on transactional processes.

Pathways From Early Family Violence to Adolescent Reactive Aggression and Violence Victimization.

PURPOSE: The current study examined how early childhood (EC) family violence and risk (i.e., maternal aggression, sibling aggression, environmental risk) predicted early adolescent (EA) reactive physical and relational aggression and violence victimization through middle childhood (MC) parenting (i.e., guilt induction, power assertive discipline). METHOD: Mother-infant dyads (N = 216; 72% African American) were recruited as part of a larger longitudinal study on prenatal cocaine and other substance exposure. Observations, interviews, and maternal and child self-report measures were collected from dyads in early childhood (1 to 36 months), middle childhood (84 months), and early adolescence (12 to 15 years). RESULTS: A cascading path model was specified where current variables were regressed on variables from the preceding time point. Primary results showed that environmental risk and EC child physical aggression predicted higher levels of MC caregiver power assertive discipline, which subsequently predicted lower levels of EA reactive relational aggression. Maternal substance use in pregnancy and the child's continuous placement with biological caregivers predicted higher levels of reactive physical aggression in EA. Finally, MC physical aggression and EA reactive relational aggression predicted higher levels of EA violence victimization. CONCLUSION: There were a series of direct paths from early childhood family violence and demographic factors to reactive aggression and violence victimization. The current study underscores the importance of evaluating multiple facets of family violence and risk when evaluating aggressive behavior and victimization.

Prenatal substance exposure and maternal hostility from pregnancy to toddlerhood: Associations with temperament profiles at 16 months of age.

We investigated whether infant temperament was predicted by level of and change in maternal hostility, a putative transdiagnostic vulnerability for psychopathology, substance use, and insensitive parenting. A sample of women (N = 247) who were primarily young, low-income, and had varying levels of substance use prenatally (69 nonsmokers, 81 tobacco-only smokers, and 97 tobacco and marijuana smokers) reported their hostility in the third trimester of pregnancy and at 2, 9, and 16 months postpartum, and their toddler's temperament and behavior problems at 16 months. Maternal hostility decreased from late pregnancy to 16 months postpartum. Relative to pregnant women who did not use substances, women who used both marijuana and tobacco prenatally reported higher levels of hostility while pregnant and exhibited less change in hostility over time. Toddlers who were exposed to higher levels of prenatal maternal hostility were more likely to be classified in temperament profiles that resemble either irritability or inhibition, identified via latent profile analysis. These two profiles were each associated with more behavior problems concurrently, though differed in their association with competence. Our results underscore the utility of transdiagnostic vulnerabilities in understanding the intergenerational transmission of psychopathology risk and are discussed in regards to the Research Domain Criteria (RDoC) framework.

PROTOCOL: Aquaculture for improving productivity, income, nutrition and women's empowerment in low- and middle-income countries: A systematic review and meta-analysis.

The review aims to examine and synthesise the state of the evidence around what works to improve productivity, income, nutrition and women's empowerment outcomes of households involved in aquaculture in low- and middle-income countries. We are particularly interested in addressing the following research questions: (1) Do aquaculture interventions increase the productivity, income, nutrition and empowerment of individuals engaged in aquaculture and their households in low- and middle-income countries? (2) Do aquaculture interventions generate income and nutrition spillover effects beyond the farmers' households? (3) To what extent do the effects of aquaculture interventions vary by intervention type, population group, and location? In particular, to what extent do effects vary by gender? (4) What are the potential barriers and facilitating factors that impact the effectiveness of aquaculture interventions? (5) What is the cost-effectiveness of different aquaculture interventions focused on productivity, income, nutrition and empowerment outcomes?

Aquaculture for improving productivity, income, nutrition and women's empowerment in low- and middle-income countries: A systematic review and meta-analysis.

Background: A steady increase in the international production and consumption of fish has positioned aquaculture as a development option. Previous literature has highlighted the potential of aquaculture to improve economic, nutritional and gender equality outcomes, however, the evidence on the effectiveness of these programmes remains unclear. Objectives: The review assessed whether aquaculture interventions increase the productivity, income, nutrition, and women's empowerment of individuals. We additionally aimed to identify barriers and facilitators that could affect the effectiveness of these interventions, and the cost-effectiveness of such programmes. Methods: We searched for experimental and quasi-experimental studies focused on low- and middle-income countries. We used standard methodological procedures expected by The Campbell Collaboration for the data collection and analysis. Results: We identified 21 impact evaluations assessing the effect of 13 aquaculture interventions in low- and lower-middle income countries. Twelve of these studies have a high risk of bias. Aquaculture interventions lead to a small increase in the production value, income, total expenditures and food consumption of participants. The limited availability of evidence prevented us from assessing other nutritional and women's empowerment outcomes. We identified barriers and facilitators affecting the programmes' set up, the participation of beneficiaries, and the level of productive activities. Insufficient cost data hindered full comparisons across programmes. Conclusions: The review suggests a lack of rigorous evidence assessing the effectiveness of aquaculture programmes. Future research could focus on evaluating nutrition and women's empowerment impacts, promoting reporting standards, and the use of cost data to continue building quality evidence around aquaculture interventions.

PROTOCOL: Strengthening women's empowerment and gender equality in fragile contexts towards peaceful and inclusive societies: A systematic review and meta-analysis.

This review builds on 3ie's (international initiative for impact evaluation) evidence gap map (EGM) of the impact evaluation and systematic review (SR) evidence base of interventions aiming to promote peaceful and inclusive societies in fragile contexts. The EGM identified a cluster of studies evaluating gender equality-focused behaviour change communication programmes and raised interest in investigating the evidence base for understanding the role of women more broadly as agents of change in developing peaceful and inclusive societies. Building on the cluster of evidence identified in the EGM, our review will increase generalisability of findings from single studies and focus on interventions across a broad range of geographical locations, settings and populations, types of implementations and outcomes. We will also address (when possible) the identified gaps in literature regarding metaanalysis in conflict-affected contexts. As such, we propose the following objectives: (1) The primary objective of this review is to identify, assess and synthesise evidence on the effect of gender specific and gender transformative interventions within the context of the four pillars of United Nations Security Council Resolution (UNSCR) 1325 on women's empowerment and gender equality in Fragile and Conflict Affected States/Situations (FCAS). The SR will facilitate the use of evidence in informing policy and practice decisions within the field of transition aid, particularly as it relates to gender focused programming. (2) Our second objective is to assess how these interventions contribute to inclusive and sustainable peace in conflict affected situations. We will compare the effectiveness of these different types of interventions through the lenses of their ecological level, types of impact on women's empowerment, local context of gender inequality and conflict. To achieve these objectives we aim to answer the following questions: (1) What are the impacts of gender transformative and specific interventions on women's empowerment and gender equality in FCAS? (2) What are the effects of these interventions on sustainable peace? (3) To what extent do effects vary by population group, ecological level and types of interventions? (4) What are contextual barriers to and facilitators of intervention effectiveness?