Comparing early-childhood and school-aged systems of care for children with emotional and behavioral difficulties: risk, symptom presentation, and outcomes

OBJECTIVES : Most large-scale evaluations of systems of care (SOCs) have focused on school-aged populations, with limited research examining early childhood SOCs. As a result, little is known about how risk profiles, symptom presentation, and outcomes may vary between early childhood and school-aged SOC participants. This descriptive study uses data from two SOCs—an early childhood SOC (EC-SOC) and a school-aged SOC (SA-SOC)—to examine the differences across age groups in how children and families present to SOCs and the extent to which risk factors and symptoms change over six months of enrollment. METHOD : Participants were 184 children in the EC-SOC (mage = 3.91) and 142 children in the SA-SOC (mage = 9.36). Families completed measures assessing risk factors and functioning at enrollment and at six-month follow up. Descriptive analyses measured the presence of risk factors and symptoms at enrollment and follow-up. Correlations were computed to determine the associations between symptom measures. RESULTS : Results identified areas of similarity and difference between families presenting for SOCs at different developmental stages. Younger children experienced greater behavioral problems (Hedge’s g = 0.52, p< 0.001) with more associated caregiver stress (Hedge’s g range = 0.34–0.62, p < 0.01) and strain (Hedge’s g = 0.34, p= 0.005). Trauma was more strongly associated with child and caregiver symptoms among younger children. Greater change in symptom measures was observed for the EC-SOC. CONCLUSIONS : Findings highlight the importance of providing services in early childhood and provide guidance for SOC service provision at different ages.The preparation of this paper was supported, in part, by the first author’s National Institutes of Health T32-funded postdoctoral training fellowship (T32DA019426-13). The New London Building Blocks project was supported by a grant from the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration. The Rhode Island Positive Educational Partnership project was supported through a cooperative agreement by the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration to the State of Rhode Island Department of Children, Youth, and Families.https://link.springer.com/journal/108262020-08-05hj2020Psycholog

Associations between paternal co-residence and child health among African American children

We investigated the associations between paternal co-residence and asthma, obesity, and blood pressure among children aged 3–5 years. Mother/child dyads (N = 250) self-identified as African American or Black. Mothers reported on father’s co-residence and child’s asthma diagnosis. Height, weight, and blood pressure were measured. Regression models were used to examine paternal co-residence with child health outcomes (i.e., asthma, obesity, and blood pressure). Confounders included maternal and child age, child sex, maternal smoking, and insurance status. Children who lived with their fathers were less likely to have asthma (OR = 0.39, 95% CI 0.18–0.79), though this association was not significant after adjustment for confounders (aOR = 0.47, 95% CI 0.22–1.01). Paternal co-residence was not significantly associated with child obesity (aOR = 0.78, 95% CI 0.35–1.73), systolic (β = 0.57, SE = 1.2, p = .64), or diastolic (β = 1.91, SE = 1.0, p = .07) blood pressure. More research is necessary to understand the diversity of family living situations and how they affect child health.The National Institutes of Health, National Institute of Nursing Research, and the National Heart, Lung, and Blood Institute.https://journals.sagepub.com/home/WJNhj2022Psycholog

Posttraumatic Stress among Young Urban Children Exposed to Family Violence and Other Potentially Traumatic Events

This study examines the relationship between the number of types of traumatic events experienced by children 3 to 6 years old, parenting stress, and children\u27s posttraumatic stress (PTS). Parents and caregivers provided data for 154 urban children admitted into community-based mental health or developmental services. By parent and caregiver report, children experienced an average of 4.9 different types of potentially traumatic events. Nearly one quarter of the children evidenced clinically significant PTS. Posttraumatic stress was positively and significantly related to family violence and other family-related trauma exposure, nonfamily violence and trauma exposure, and parenting stress. Additionally, parenting stress partially mediated the relationship between family violence and trauma exposure and PTS. This study highlights the need for early violence and trauma exposure screening in help-seeking populations so that appropriate interventions are initiated

The association between neighborhood social vulnerability and cardiovascular health risk among Black/African American women in the InterGEN Study

BACKGROUND : Black/African American women in the United States are more likely to live in neighborhoods with higher social vulnerability than other racial/ethnic groups, even when adjusting for personal income. Social vulnerability, defined as the degree to which the social conditions of a community affect its ability to prevent loss and suffering in the event of disaster, has been used in research as an objective measure of neighborhood social vulnerability. Black/African American women also have the highest rates of hypertension and obesity in the United States. OBJECTIVES : The purpose of this study was to examine the relationship between neighborhood social vulnerability and cardiovascular risk (hypertension and obesity) among Black/African American women. METHODS : We conducted a secondary analysis of data from the InterGEN Study that enrolled Black/African American women in the Northeast United States. Participants’ addresses were geocoded to ascertain neighborhood vulnerability using the Centers for Disease Control and Prevention’s Social Vulnerability Index at the census tract level. We used multivariable regression models to examine associations between objective measures of neighborhood quality and indicators of structural racism and systolic and diastolic blood pressure and obesity (body mass index > 24.9) and to test psychological stress, coping, and depression as potential moderators of these relationships. RESULTS : Seventy-four percent of participating Black/African American women lived in neighborhoods in the top quartile for social vulnerability nationally. Women living in the top 10% of most socially vulnerable neighborhoods in our sample had more than a threefold greater likelihood of hypertension when compared to those living in less vulnerable neighborhoods. Objective neighborhood measures of structural racism (percentage of poverty, percentage of unemployment, percentage of residents >25 years old without a high school diploma, and percentage of residents without access to a vehicle) were significantly associated with elevated diastolic blood pressure and obesity in adjusted models. Psychological stress had a significant moderating effect on the associations between neighborhood vulnerability and cardiovascular risk. DISCUSSION : We identified important associations between structural racism, the neighborhood environment, and cardiovascular health among Black/African American women. These findings add to a critical body of evidence documenting the role of structural racism in perpetuating health inequities and highlight the need for a multifaceted approach to policy, research, and interventions to address racial health inequities.http://journals.lww.com/nursingresearchonlinehj2022Psycholog

The intergenerational impact of genetic and psychological factors on blood pressure study (InterGEN) : design and methods for recruitment and psychological measures

BACKGROUND : Although studies show that genomics and environmental stressors affect blood pressure, few studies have examined their combined effects, especially in African Americans. OBJECTIVE : We present the recruitment methods and psychological measures of the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure (InterGEN) study, which seeks to investigate the individual and combined effects of genetic (G) and environmental (E) (psychological) stressors on blood pressure in African American mother-child dyads. Genetic methods are presented elsewhere, but here we present the recruitment methods, psychological measures, and analysis plan for these environmental stressors. METHODS : This longitudinal study will enroll 250 mother-child dyads (N = 500). Study participation is restricted to women who (a) are ≤21 years of age, (b) self-identify as African American or Black, (c) speak English, (d) do not have an identified mental illness or cognitive impairment, and (e) have a biological child between 3 and 5 years old. The primary environmental stressors assessed are parenting stress, perceived racism and discrimination, and maternal mental health. Covariates include age, cigarette smoking (for mothers), and gender (for children). The study outcome variables are systolic and diastolic blood pressure. ANALYSIS : The main analytic outcome is genetic-by-environment interaction analyses (G × E); however, main effects (G) and (E) will be individually assessed first. Genetic (G) and interaction analyses (G × E) are described in a companion paper and will include laboratory procedures. Statistical modeling of environmental stressors on blood pressure will be done using descriptive statistics and generalized estimating equation models. IMPLICATIONS : The methodology presented here includes the study rationale, community engagement and recruitment protocol, psychological variable measurement, and analysis plan for assessing the association of environmental stressors and blood pressure. This study may provide the foundation for other studies and development of interventions to reduce the risk for hypertension and to propose targeted health promotion programs for this high-risk population.http://journals.lww.com/nursingresearchonline2017-07-31hb2016Psycholog

Law enforcement assisted diversion : qualitative evaluation of barriers and facilitators of program implementation

BACKGROUND : Despite widespread interest in adoption, there has been limited systematic examination of Law Enforcement Assisted Diversion (LEAD) implementation, a model for police-led arrest diversion for those with substance use disorders (SUD). In the fall of 2017, the City of New Haven started a LEAD program. During the first 9 months of the pilot, only 2 clients were successfully diverted from arrest. Therefore, we examined the and barriers and facilitators of LEAD implementation. METHODS : We conducted semi-structured interviews and field observations of LEAD police officers and health care providers between August 2018 and June 2019. Interviews and field observations were analyzed using directed content analysis and guided by the Integrated Promoting Action on Research Implementation in Health Services framework. RESULTS : Lead professionals participated in 19 semi-structured interviews and three field observations. Barriers to arrest diversion implementation included procedural complexity of arrest diversion, concerns about reduced penalties for substance use among officers, stigma of SUDs, and a belief in a punitive role for policing. Facilitators included a positive longitudinal relationship with potential clients and an understanding of SUD as a chronic disease. CONCLUSION : We identified several barriers to LEAD implementation. Our results suggest promotion of SUD as a chronic disease, ongoing training of officers, and positive incentives for entering substance use treatment should be utilized to facilitate implementation.SUPPLEMENTARY MATERIAL : Appendix A: Interview guideThe National Institutes of Health (NIH) and the Department of Veterans Affairs.https://www.elsevier.com/locate/jsat2022-05-14hj2022Psycholog

Experiences of trauma and DNA methylation profiles among African American mothers and children

Potentially traumatic experiences have been associated with chronic diseases. Epigenetic mechanisms, including DNA methylation (DNAm), have been proposed as an explanation for this association. We examined the association of experiences of trauma with epigenome-wide DNAm among African American mothers (n = 236) and their children aged 3–5 years (n = 232; N = 500), using the Life Events Checklist-5 (LEC) and Traumatic Events Screening Inventory—Parent Report Revised (TESI-PRR). We identified no DNAm sites significantly associated with potentially traumatic experience scores in mothers. One CpG site on the ENOX1 gene was methylome-wide-significant in children (FDR-corrected q-value = 0.05) from the TESI-PRR. This protein-coding gene is associated with mental illness, including unipolar depression, bipolar, and schizophrenia. Future research should further examine the associations between childhood trauma, DNAm, and health outcomes among this understudied and high-risk group. Findings from such longitudinal research may inform clinical and translational approaches to prevent adverse health outcomes associated with epigenetic changes.The National Institutes of Health, National Institute of Nursing Research; a Yale School of Nursing Alumni Donor; the National Institutes of Health Medical Scientist Training Program Grant and the Robert Wood Johnson Foundation Health Policy Research Scholars Program.https://www.mdpi.com/journal/ijmsPsycholog

Association of obesity with DNA methylation age acceleration in African American mothers from the InterGEN study

African American women are a ected by earlier onset of age-associated health deteriorations and obesity disproportionally, but little is known about the mechanism linking body mass index (BMI) and biological aging among this population. DNA methylation age acceleration (DNAm AA), measuring the di erence betweenDNAmethylation age and chronological age, is a novel biomarker of the biological aging process, and predicts aging-related disease outcomes. The present study estimated cross-tissue DNA methylation age acceleration using saliva samples from 232 African American mothers. Cross-sectional regression analyses were performed to assess the association of BMI with DNAmAA. The average chronological age andDNAmethylation age were 31.67 years, and 28.79 years, respectively. After adjusting for smoking, hypertension diagnosis history, and socioeconomic factors (education, marital status, household income), a 1 kg/m2 increase in BMI is associated with 0.14 years increment of DNAm AA (95% CI: (0.08, 0.21)). The conclusion: in African American women, high BMI is independently associated with saliva-based DNA methylation age acceleration, after adjusting for smoking, hypertension, and socioeconomic status. This finding supports that high BMI accelerates biological aging, and plays a key role in age-related disease outcomes among African American women.National Institutes of Health granthttps://www.mdpi.com/journal/ijmspm2020Psycholog

Associations between DNA methylation age acceleration, depressive symptoms, and cardiometabolic traits in African American mothers from the InterGEN study

Background : African American women (AAW) have a high risk of both cardiometabolic (CM) illness and depressive symptoms. Depressive symptoms co-occur in individuals with CM illness at higher rates than the general population, and accelerated aging may explain this. In this secondary analysis, we examined associations between age acceleration; depressive symptoms; and CM traits (hypertension, diabetes mellitus [DM], and obesity) in a cohort of AAW. Methods : Genomic and clinical data from the InterGEN cohort (n = 227) were used. Age acceleration was based on the Horvath method of DNA methylation (DNAm) age estimation. Accordingly, DNAm age acceleration (DNAm AA) was defined as the residuals from a linear regression of DNAm age on chronological age. Spearman’s correlations, linear and logistic regression examined associations between DNAm AA, depressive symptoms, and CM traits. Results : DNAm AA did not associate with total depressive symptom scores. DNAm AA correlated with specific symptoms including selfdisgust/ self-hate (−0.13, 95% CI −0.26, −0.01); difficulty with making decisions (−0.15, 95% CI −0.28, −0.02); and worry over physical health (0.15, 95% CI 0.02, 0.28), but were not statistically significant after multiple comparison correction. DNAm AA associated with obesity (0.08, 95% CI 1.02, 1.16), hypertension (0.08, 95% CI 1.01, 1.17), and DM (0.20, 95% CI 1.09, 1.40), after adjustment for potential confounders. Conclusions : Associations between age acceleration and depressive symptoms may be highly nuanced and dependent on study design contexts. Factors other than age acceleration may explain the connection between depressive symptoms and CM traits. AAW with CM traits may be at increased risk of accelerated aging.The InterGEN study was funded by the National Institute of Nursing Research of the National Institutes of Health (R01NR013520).https://journals.sagepub.com/home/gaeam2023Psycholog