Promoting Health Intervention Strategies from Social and Behavioral Research (2000) / Chapter Skim
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Paper Contribution D: The Healthy Development of Young Children: SES Disparities, Prevention Strategies, and Policy Opportunities
Paper Contribution D: The Healthy Development of Young Children: SES Disparities, Prevention Strategies, and Policy Opportunities
Pages 170-216
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From page 170... ...
2We wish to thank Brian Smedley, Marie McCormick, Hortensia Amaro, and the Institute of Medicine Committee on Capitalizing on Social Science and Behavioral Research to Improve the Public's Health for their support in the writing of this paper. We are grateful for the support of the MacArthur Network on the Family and the Economy, the National Institute of Child Health and Human Development Research Network on Child and Family Well-Being, and the Administration of Children, Youth and Families and National Institute for Mental Health Research Consortium on Mental Health in Head Start.
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From page 171... ...
DEFINING HEALTHY DEVELOPMENT FOR YOUNG CHILDREN The dimensions of school readiness outlined by the Goal 1 Technical Planning Group (1993) include aspects of physical health, as well as social, emotional, and cognitive development.
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list four domains of well-being that are applicable to young children: (1) physical health (including birthweight, growth, and conditions such as blood-lead levels)
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First, broad conceptualizations include domains that are usually considered under the rubric of health, defined by the World Health Organization (WHO, 1978) as: "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." In addition to physical health, other competencies are required under this definition.
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From page 174... ...
In the first, teachers rated the most important characteristics of school readiness, these were physical health, communication skills, enthusiasm, taking turns, and the ability to sit and pay attention. In a second study, a sample of 7,000 kindergarten teachers estimated that only 65% of their students in the fall of 1990 were ready for school.
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From page 175... ...
Among children, SES is also a strong predictor of health and development (e.g., Brooks-Gunn and Duncan, 1997, Duncan and Brooks-Gunn, 1997~. In this section, we present SES disparities in young children's outcomes, including cognitive and language development, emotional health, and physical health, and discuss the relative importance of separate factors of SES (e.g., parental education and family income)
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From page 176... ...
For instance, different programs might be designed depending on whether parental education or family income is more important for child outcomes. If maternal education seems to be more highly related, we might want to emphasize programs that increase mothers' human capital, such as GED completion programs, dropout prevention, or literacy programs.
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From page 177... ...
on child development. The third topic is neighborhood income.
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From page 178... ...
Total family income was positively associated with verbal scores and achievement test scores as well as intelligence test scores for children ranging in age from 3 to 8 years (Duncan et al., 1994, Smith et al., 1997, Klebanov et al., 1998~. Effect sizes for family income ranged from .20 to .32, even after controlling for mothers' education.
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From page 179... ...
Among children ages 3 to 17 years in the 1988 National Health Interview Survey Child Health Supplement, parents of poor children were more likely to report that they had had an emotional or behavioral problem lasting 3 months or more (Brooks-Gunn and Duncan, 1997~. Higher family income-to-needs ratio is associated with lower levels of externalizing problems in the IHDP and NLSY samples at ages 3 through 6 (Brooks-Gunn et al., 1993, Chase-Lansdale et al., 1997~.
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Summary We find that maternal education, family income, and neighborhood income each have independent effects on child cognitive, emotional, and physical outcomes. Maternal education tends to be strongly associated with all types of cognitive assessments (cognitive, verbal, and school achievement measures)
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Although these SES indicators account for a substantial portion of the variance in child outcomes, other factors are important as well. Low levels of family income and maternal education each represent risk factors for children.
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PROCESSES OPERATING IN SES LINKS TO CHILD HEALTH Why does SES affect child health and development in the ways described above? How can we explain the processes by which SES factors such as family income, maternal education, and neighborhood income affect children's cognitive, linguistic, social, emotional, and physical well-being?
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For example, a study of low-wage-earning single mothers in New York City found some support for the model in Figure 1. Specifically, maternal education and earnings were directly related to financial strain, which in turn affected maternal depressive symptoms.
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These results parallel those for fathers reported by Elder (1974) in his work on the children of the Great Depression, that paternal emotional distress and parenting mediated the link between job loss and child outcomes (see also Conger et al., 1992, for a similar model for children from rural farm families)
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From page 185... ...
Neighborhood income is similar to family income in that it is a structural feature. The question here is how neighborhood residence might influence parental provision of stimulating experiences, sensitivity, and warmth.
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From page 186... ...
These resources may be of most interest regarding children's achievement outcomes since the availability of libraries, museums, and learning programs in the community may affect parent's provision of such experiences outside the home and, in turn, children's school readiness and achievement. Social and recreational activities may affect children's physical and social development, and the availability of quality child health care may affect parent's usage of health care services for their children and, in turn, children's physical health.
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, who receive subsidies for purchasing child care and who may qualify for high-quality intervention programs, such as Head Start, than for less poor families (families with incomes above the poverty line)
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From page 188... ...
For instance, children who experienced poor-quality early child care settings exhibit lower math and language scores, worse peer relations, and more behavior problems in second grade (Cost, Quality and Child Outcomes Study Team, 1999~. Within Head Start classrooms, classroom quality is associated with early literacy and math skills (Zill et al., 1998~.
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Below, we review the relative successes of such efforts to support and improve the health and development of young children. Family-Level Interventions Prevention efforts that focus on the family as the mechanism by which low SES affects young children include home-visiting programs, intergenerational or family literacy programs, and family support programs.
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The Hawaii Healthy Start program, designed to promote positive parenting, enhance child development, ensure that children have a regular physician and "medical home," and prevent child abuse and neglect, did
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. One evaluation of the national Even Start Family Literacy Program that randomized treatment at five sites found positive program effects on school readiness and language scores for 3and 4-year-old program participants (St.
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Given their focus on literacy, family literacy program evaluation has not focused on child outcomes beyond cognitive and language achievement. The research to date does not provide data on social, emotional, or behavioral outcomes for children, nor does it follow the children longitudinally to assess the stability of the cognitive gains into the school years.
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From page 193... ...
Findings for effects on parents are relatively few: for universal-access programs, some associations have been found for increased parent knowledge of child development, parenting attitudes and behaviors, and improved parental feelings of social support, coping, and reduced family stress (Pfannenstiel and Seltzer, 1989, Pfannenstiel et al., 1991, Barnes et al., 1995~. Physical health, education, and employment effects on mothers in universal-access family support programs have not been reported (Barnes et al., 1995~.
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From page 194... ...
Second, IHDP data were used to test the pathway from program effects on parents to child outcomes. The data supported a pathway, similar to that found in Figure 1, by which participation in the intervention program reduced maternal depression, which was associated with improved parenting behaviors and, in turn, affected child test scores.
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From page 195... ...
Indeed, many interventions designed to enhance the healthy development of children from low-SES families have focused on the provision of highquality, developmentally appropriate center-based child care. Model preschool programs, such as the Perry Preschool, and large-scale public programs such as Head Start, each emerged in the 1960s War on Poverty a movement to enhance the learning experiences and other support of children from poor families.
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Fourth, nutritious meals and snacks provided at centers may substantially improve the diets of economically disadvantaged children (Gomby et al., 1995~. However, few studies have focused on children's physical health.
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they include high-quality child care as a form of direct service to young children. CONCLUSIONS AND OPPORTUNITIES FOR FUTURE RESEARCH There is great interest currently in positive child development and health, which is being discussed under the rubric of positive child outcomes, wellbeing, and health (Moore et al., in press)
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Aspects of programs (e.g., duration, intensity, and mode of service delivery) , participants (e.g., maternal education and the number of risk factors the family has)
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In part, this means accepting maternal outcomes and parenting outcomes as important in their own right, as well as focusing on children's social, emotional, and physical health. The overwhelming historical focus on IQ and cognitive outcomes has not represented this broad conceptualization of healthy development and arguably has resulted in underestimation of the effects of intervention programs on children.
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From page 200... ...
One of the big gaps in the literature on the efficacy of early childhood intervention programs is that studies have not looked at the efficacy of such programs for immigrant children. With the growing population of immigrant children who may need special early childhood services (Lewitt and Baker, 1994)
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We have argued for the importance of considering social and emotional development as indicators of healthy development and school readiness, and have highlighted teachers' concerns about children's behavioral functioning in the classroom. Parents of young children also express concern about these areas of functioning.
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. However, rates of referral into mental health services for emotional disturbances among Head Start children are relatively low: only 4% of those with identified disabilities are diagnosed with an emotional or behavioral disability (Knitzer, in press)
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Recent longitudinal data from more than 800 children who had attended 170 different child care centers suggests that early child care quality is associated with math and language skills as well as peer relations and behavior problems in second grade (Cost, Quality and Child Outcomes Study Team, 1999~. The National Association for the Education of Young Children has outlined the characteristics of developmentally appropriate practices in early childhood settings (Bredekamp and Copple, 1997)
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Often, evaluations are conducted on programs that are not being fully implemented, and this reduces the likelihood of getting positive results. Currently, the Early Head Start Research and Evaluation Project is paying more attention to the definitions of full implementation across a variety of dimensions (Mathematica Policy Research, 1999~.
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There is a trade-off between the amount of intervention that can be provided and the number of families that can be served. If a program can only offer thin services in order to serve all families, there may be no positive child outcomes at all.
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We conclude, as did Bronfenbrenner, that high-quality early childhood programs can have significant effects on cognitive outcomes for children, especially when the children are from low-income families and especially when the programs provide both child and family services. What has changed in the more than 30 years since the programs that began in the 1960s and 1970s were first evaluated is a change from deficit models to models focusing on the strengths of families.
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(19824. The skills of mothering: A study of parent child development centers.
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Child Development, 68, 935954.
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Cost, Quality and Child Outcomes Study Team (1995~. Cost, Quality, and Child Outcomes in Child Care Centers.
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Child Development, 51, 426-436. Galinsky, E., Howes, C., Kontos, S., and Shinn, M
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(1998~. The contribution of neighborhood and family income to developmental test scores over the first three years of life.
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A longitudinal follow-up comparison of disadvantaged children attending Head Start, no preschool, and other preschool programs. Child Development, 61, 495-507.
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Child Development, 61, 85-98. Madden, J., O'Hara, J., Levenstein, P
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. What are good child outcomes?
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Child Development, 65, 472-492. Power, C., Matthews, S., and Manor, O
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(1994~. National Evaluation of the Comprehensive Child Development Program: Report to Congress.
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