Evaluation of a longitudinal family stress model in a population‐based cohort

The family stress model (FSM) is an influential family process model that posits that socioeconomic disadvantage impacts child outcomes via its effects on the parents. Existing evaluations of the FSM are constrained by limited measures of socioeconomic disadvantage, cross‐sectional research designs, and reliance on non‐population‐based samples. The current study tested the FSM in a subsample of the Fragile Families and Child Wellbeing Study (N = 2,918), a large population‐based study of children followed from birth through the age of nine. We employed a longitudinal framework and used measures of socioeconomic disadvantage beyond economic resources. Although the hypothesized FSM pathways were identified in the longitudinal model (e.g., economic pressure at the age of one was associated with maternal distress at the age of three, maternal distress at the age of three was associated with parenting behaviors at the age of five), the effects of socioeconomic disadvantage at childbirth on youth socioemotional outcomes at the age of nine did not operate through all of the hypothesized mediators. In longitudinal change models that accounted for the stability in constructs, multiple indicators of socioeconomic disadvantage at childbirth were indirectly associated with youth externalizing behaviors at the age of nine via either economic pressure at the age of one or changes in maternal warmth from ages 3 to 5. Greater economic pressure at the age of one, increases in maternal distress from ages 1 to 3, and decreases/increases in maternal warmth/harshness from ages 3 to 5 were also directly associated with increases in externalizing behaviors from ages 5 to 9. Results provide partial support for the FSM across the first decade of life.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163397/2/sode12446.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163397/1/sode12446_am.pd

Uneven progress in reducing exposure to violence at home for New Zealand adolescents 2001–2012: a nationally representative cross‐sectional survey series

Objective: To explore trends, and identify risk factors, that may explain changes in adolescent exposure to family violence over time.Methods: Data for this study was drawn from the Youth 2000 series of cross‐sectional surveys, carried out with New Zealand high school students in 2001, 2007 and 2012. Latent class analysis was used to understand different patterns of exposure to multiple risks for witnessing violence at home among adolescents.Results: Across all time periods, there was no change in witnessing emotional violence and a slight decline in witnessing physical violence at home. However, significant differences were noted between 2001 and 2007, and 2007 and 2012, in the proportion of adolescents who reported witnessing emotional and physical violence. Four latent classes were identified in the study sample; these were characterised by respondents' ethnicity, concerns about family relationships, food security and alcohol consumption. For two groups (characterised by food security, positive relationships and lower exposure to physical violence), there was a reduction in the proportion of respondents who witnessed physical violence but an increase in the proportion who witnessed emotional violence between 2001 and 2012. For the two groups characterised by poorer food security and higher exposure to physical violence, there were no changes in witnessing of physical violence in the home.Implications for public health: In addition to strategies directly aimed at violence, policies are needed to address key predictors of violence exposure such as social disparities, financial stress and alcohol use. These social determinants of health cannot be ignored

Tanzanian lessons in using non-physician clinicians to scale up comprehensive emergency obstetric care in remote and rural areas

UNLABELLED\ud \ud ABSTRACT:\ud \ud BACKGROUND\ud \ud With 15-30% met need for comprehensive emergency obstetrical care (CEmOC) and a 3% caesarean section rate, Tanzania needs to expand the number of facilities providing these services in more remote areas. Considering severe shortage of human resources for health in the country, currently operating at 32% of the required skilled workforce, an intensive three-month course was developed to train non-physician clinicians for remote health centres.\ud \ud METHODS\ud \ud Competency-based curricula for assistant medical officers' (AMOs) training in CEmOC, and for nurses, midwives and clinical officers in anaesthesia and operation theatre etiquette were developed and implemented in Ifakara, Tanzania. The required key competencies were identified, taught and objectively assessed. The training involved hands-on sessions, lectures and discussions. Participants were purposely selected in teams from remote health centres where CEmOC services were planned. Monthly supportive supervision after graduation was carried out in the upgraded health centres\ud \ud RESULTS\ud \ud A total of 43 care providers from 12 health centres located in 11 rural districts in Tanzania and 2 from Somalia were trained from June 2009 to April 2010. Of these 14 were AMOs trained in CEmOC and 31 nurse-midwives and clinical officers trained in anaesthesia. During training, participants performed 278 major obstetric surgeries, 141 manual removal of placenta and evacuation of incomplete and septic abortions, and 1161 anaesthetic procedures under supervision. The first 8 months after introduction of CEmOC services in 3 health centres resulted in 179 caesarean sections, a remarkable increase of institutional deliveries by up to 300%, decreased fresh stillbirth rate (OR: 0.4; 95% CI: 0.1-1.7) and reduced obstetric referrals (OR: 0.2; 95% CI: 0.1-0.4)). There were two maternal deaths, both arriving in a moribund condition.\ud \ud CONCLUSIONS\ud \ud Tanzanian AMOs, clinical officers, and nurse-midwives can be trained as a team, in a three-month course, to provide effective CEmOC and anaesthesia in remote health centres

Children's Elevated Risk of Asthma in Unmarried Families

The Fragile Families and Child Wellbeing Study is following a birth cohort of nearly 5,000 children, including 3,712 children born to unmarried parents and 1,186 children born to married parents. The data are nationally representative of births in cities with populations of 200,000 or more. For more information about the study, visit the Web site of The Center for Research on Child Wellbeing, http://crcw.princeton.edu/fragilefamilies or email the CRCW at [email protected] This research brief was adapted from "Children’s Elevated Risk of Asthma in Unmarried Families: Underlying Structural and Behavioral Mechanisms" by Kristen Harknett. To download a copy of the paper on which this brief was based, visit http://crcw.princeton.edu, go to the Fragile Families link, click on Publications, then click on Working Papers Series. The Fragile Families Research Brief is funded in part by a grant from the Annie E. Casey Foundation

Predictors of Homelessness and Doubling-Up Among At Risk Families

For more information about the Fragile Families and Child Wellbeing Study, go to http://www.fragilefamilies.princeton.edu and go to “About Fragile Families” and “Collaborative Studies.” To review public and working papers from the Fragile Families Study, go to http://www.fragilefamilies.princeton.edu/ffpubs.asp. This research brief was adapted from “Homelessness Among At Risk Families with Children in 20 American Cities” by Angela Fertig and David Reingold (forthcoming in Social Service Review, September 2008, Vol. 82 No. 3). A Publication of the Woodrow Wilson School of Public and International Affairs at Princeton University

Do Good Partners Make Good Parents? Relationship Quality and Parenting in Married and Unmarried Families

The Fragile Families and Child Wellbeing Study is following a birth cohort of nearly 5,000 children, including 3,712 children born to unmarried parents and 1,186 children born to married parents. The data are nationally representative of births in cities with populations of 200,000 or more. For more information about the study, visit the Web site of The Center for Research on Child Wellbeing, http://crcw.princeton.edu/fragilefamilies or email the CRCW at [email protected] This research brief was adapted from "Do Good Partners Make Good Parents? Relationship Quality and Parenting in Married and Unmarried Families" by Marcia Carlson and Sara McLanahan. To download a copy of the paper on which this brief was based, visit http://crcw.princeton.edu, go to the Fragile Families link, click on Publications, then click on Working Papers Series. The Fragile Families Research Brief is funded in part by a grant from the Annie E. Casey Foundation