家庭社会经济状况对婴幼儿认知发育的影响

目的:研究反映家庭社会经济状况的主要因素家庭年人均可支配收入和双亲文化程度对婴幼儿的认知应物测验/临床语言和听力进程量表(Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale,CAT/CLAMS)发育商(DQ)的影响。方法:采用CAT/CLAMS对上海市4~36个月常模婴幼儿进行测试,计算各婴幼儿CAT/CLAMS语言能DQ、应物能DQ及认知能DQ。同时调查家庭年人均可支配收入和双亲文化程度。采用非参数统计的方法比较组间差异。结果:家庭年人均可支配收入对婴幼儿CAT/CLAMS的3种DQ均有极显著影响(P<0.01);母亲文化程度对婴幼儿CAT/CLAMS的应物能和认知能这两种DQ有显著的影响(P<0.05);父亲文化程度对婴幼儿CAT/CLAMS的3种DQ均无明显影响。结论:社会经济状况对婴幼儿的发育具有明显的促进作用;对婴幼儿尤其是对低收入、母亲低学历家庭的婴幼儿进行发育监测十分必要。     

Health and nutritional status of infants in a population of the Center-Western region of Brazil]

OBJECTIVE: To evaluate the nutritional status of infants who reside in the city of Campo Grande, State of Mato Grosso do Sul, Brazil. METHODS: The method used was that of a cross sectional household study by means of an anthropometric social survey, sampling 652 children from 0 to 59 months of age. RESULTS: A low prevalence of nutritional deficit, excepting that of height-for-age, starting in the first year of life, was found. The nutritional status proved to be influenced by the socioeconomic conditions, especially concerning per capita family income. Nearly all children started breast-feeding but were weaned during the first month. Exclusive breast-feeding is of short duration and soon replaced by infant formula. The survey of mother-child assistance demonstrated an excellent coverage of prenatal care, but inadequacy in the follow-up of the child's health at all income levels. CONCLUSIONS: The need to carry out changes in the approach to preventive actions and in the monitoring of the nutritional situation of the children, concerning the problems identified in this study in order to allow for the development of differential actions in the nutritional field has been identified.     

The use of national sample surveys for nutritional surveillance: lessons from Malawi's National Sample Survey of Agriculture

National sample surveys, containing measurements of the weights and heights of children along with other socioeconomic modules, represent one of the important sources of information for nutritional surveillance. The potential uses of such information are political sensitization, targeting by geographic area, targeting by socioeconomic group, and identifying the most promising intervention options according to the presumed causes of malnutrition. The latter two applications depend upon the ability to detect stable associations between nutritional status and socioeconomic factors. This paper examines the extent to which these planning applications are affected by variation in the ecology of malnutrition across different segments of society, using Malawi's National Sample Survey of Agriculture (NSSA). The NSSA is nationally representative of Malawi's smallholder sector and contains information on anthropometrics of underfives and various socioeconomic characteristics of their households. This analysis is based upon 3000 households containing at least one underfive, with one child per household being selected for analysis. Height-for-age Z-scores (HAZ) are calculated using WHO standards, and analyzed using analysis of variance (ANOVA). Variation in nutritional ecology is investigated by examining statistical interactions among socioeconomic variables as they relate to HAZ and by comparing ANOVA models constructed within several sample strata. These strata are defined according to geographic region, size of cultivated area, child's sex, child's age and, for a subsample, ethnic/religious identification. The results demonstrate that significant two-way interactions exist between region, cultivated area, household labor availability and age of the child. For the total sample HAZ declines with increasing cultivated area among young children (less than 24 months) but improves with increasing cultivated area among older children (greater than or equal to 24 months). The overall trend for young children is region-specific, however, such that no generalizations can be made concerning the effects of region and cultivated area without taking the other factor and child's age into account. Similarly, cultivated area interacts with household labor availability among young children, such that more labor is associated with lower HAZ on plots less than 0.7 ha, but more labor is associated with higher HAZ on plots above 1.5 ha. The existence of variation in nutritional ecology is further borne out by the observed variation in multivariable ANOVA models constructed within various sample strata. It is concluded that significant variation in nutritional ecology does exist between various segments of society. This limits the usefulness of national sample surveys for selecting intervention options and for targeting interventions according to socioeconomic characteristics.     

Family structure, socioeconomic status, and access to health care for children

OBJECTIVE: To test the hypothesis that among children of lower socioeconomic status (SES), children of single mothers would have relatively worse access to care than children in two-parent families, but there would be no access difference by family structure among children in higher SES families. DATA SOURCES: The National Health Interview Surveys of 1993-95, including 63,054 children. STUDY DESIGN: Logistic regression was used to examine the relationship between the child's family structure (single-mother or two-parent family) and three measures of health care access and utilization: having no physician visits in the past year, having no usual source of health care, and having unmet health care needs. To examine how these relationships varied at different levels of SES, the models were stratified on maternal education level as the SES variable. The stratified models adjusted for maternal employment, child's health status, race and ethnicity, and child's age. Models were fit to examine the additional effects of health insurance coverage on the relationships between family structure, access to care, and SES. PRINCIPAL FINDINGS: Children of single mothers, compared with children living with two parents, were as likely to have had no physician visit in the past year; were slightly more likely to have no usual source of health care; and were more likely to have an unmet health care need. These relationships differed by mother's education. As expected, children of single mothers had similar access to care as children in two-parent families at high levels of maternal education, for the access measures of no physician visits in the past year and no usual source of care. However, at low levels of maternal education, children of single mothers appeared to have better access to care than children in two-parent families. Once health insurance was added to adjusted models, there was no significant socioeconomic variation in the relationships between family structure and physician visits or usual source of care, and there were no significant disparities by family structure at the highest levels of maternal education. There were no family structure differences in unmet needs at low maternal education, whereas children of single mothers had more unmet needs at high levels of maternal education, even after adjustment for insurance coverage. CONCLUSIONS: At high levels of maternal education, family structure did not influence physician visits or having a usual source of care, as expected. However, at low levels of maternal education, single mothers appeared to be better at accessing care for their children. Health insurance coverage explained some of the access differences by family structure. Medicaid is important for children of single mothers, but children in two-parent families whose mothers are less educated do not always have access to that resource. Public health insurance coverage is critical to ensure adequate health care access and utilization among children of less educated mothers, regardless of family structure.     

Respiratory illnesses in children younger than 5 years of age in southern Brazil: the influence of the home environment]

OBJECTIVE: To determine the prevalence of acute lower respiratory tract infections and the risk factors associated with living conditions among children up to 5 years of age in the city of Rio Grande, in the state of Rio Grande do Sul, Brazil. METHODS: A population-based cross-sectional study was carried out with 775 children. A standardized questionnaire was administered to the mother or other caregiver at the child's home in order to collect information on housing conditions, socioeconomic status, and smoking in the home. Additional variables examined included nutritional status, duration of breast-feeding, prenatal care, and utilization of health care services. Environmental variables were analyzed individually and were also grouped together in an "environmental score" that encompassed 10 variables: type of house construction, type of floor, home heating system, type of stove, dog in the child's room, dog in the house, cat in the child's room, cat in the house, number of people per room, and maternal smoking. The grouped environmental score ranged from 0 (best) to 10 (worst). The analysis included two stages: a bivariate stage, in which the prevalence ratio was calculated for each risk factor, and a multivariate stage, with logistic regression. RESULTS: The overall prevalence of acute lower respiratory tract infections was 23.9%. The main risk factors identified were: environmental score >/= 3 points, maternal schooling < 5 years, monthly family income < US$ 200, four or more people sharing the child's bedroom, and maternal smoking. Maternal age > or = 30 years was found to protect against the development of respiratory illness. CONCLUSIONS: Specific programs need to be implemented to control acute respiratory illnesses in the population studied. In future studies with this population, the environmental score that we developed could be used in place of the complete set of environmental variables that we tested. This environmental score should be applied in other contexts so as to determine its external validity.     

Child feeding practices and household food insecurity among low-income mothers in Buenos Aires, Argentina

This qualitative study of low-income mothers in Buenos Aires, Argentina, examines the influence of socio-economic conditions, organizational structures, family relationships, and food insecurity on child feeding practices and weight status. Thirty-eight mothers of preschool children living in urban Buenos Aires participated in four focus group discussions. The results indicated that many mothers were aware that obesity may be detrimental to the child's health, but most of them are unclear about the specific consequences. Maternal employment, family pressures, food insecurity and financial worries seem to influence child feeding practices. These findings have important implications for developing strategies for nutritional assistance that could benefit the health of children and provide opportunities for educational programs that are directed to nutritional awareness in Buenos Aires, Argentina. The right to eat regularly and properly is an obligation of the State and must be implemented taking into account the notion of food sovereignty and respecting the importance of preserving the culture and eating habits of a country and its diverse population groups.     

Women's education can improve child nutrition in India

Child malnutrition has long been recognized as a serious problem in India, but national-level data on levels and causes of malnutrition have been scarce. Hence, during 1992-93, a National Family Health Survey was carried out to examine the levels and determinants of child malnutrition in the country. More specifically, this survey estimated the levels of child malnutrition and examined the effects of mother's education and other demographic and socioeconomic factors on the nutritional status of children in India. Based on standards developed by the WHO, 52% of children under age 4 years are stunted, 17% are wasted, and 54% are underweight. Maternal education has the strongest independent influence on child malnutrition. Children whose mothers have little or no education tend to have a lower nutritional status than do children of more-educated mothers, even after controlling potentially confounding demographic and socioeconomic variables. The age of the child, birth order, and household economic status all have independent effects on nutritional status. Considering the very strong impact of maternal education on child nutrition, women's education and literacy programs could play an important role in improving the nutritional status of children.     

家庭社会经济地位对儿童超重肥胖的影响——饮食行为的中介效应

目的 研究家庭社会经济地位（SES）对儿童超重肥胖的影响以及饮食行为的中介作用。方法 采用分层整群抽样方法,使用自制问卷于2020年对徐州市幼儿园儿童家长进行调查和常规儿童体格测量,以父母最高文化程度、职业和家庭月收入反映家庭SES,学龄前儿童饮食行为量表（PEBS）评价饮食行为,AMOS 21.0构建结构方程模型分析家庭SES和儿童超重肥胖的关联以及饮食行为的中介作用。结果 1 969名学龄前儿童中超重率为8.5%、肥胖率为6.2%,家庭SES得分为0.00（ - 0.66,0.84）分,模型显示,较低的SES与子代超重/肥胖高风险相关（效应值为 - 0.056）,饮食行为的间接效应系数为 - 0.008（95%CI: - 0.015～ - 0.003）。结论 家庭SES可直接或间接通过饮食行为影响学龄前儿童超重肥胖,未来应指导父母帮助儿童建立良好饮食行为,这对于预防和控制儿童超重与肥胖具有重要意义。     

The deterioration in children's nutritional status in rural Chad: the effect of mothers' influence on feeding.

OBJECTIVES: This study examined how maternal influence on child feeding modified the deterioration of child nutritional status in Chad. METHODS: The pattern of height with age was examined in 98 rural Chadian children aged 12 through 71 months from 64 households randomly chosen. RESULTS: Younger children were more stunted than older ones, probably reflecting secular deterioration in weanlings' nutritional status from 1982 to 1987. Children of mothers with influence over child feeding were taller than children of mothers with less influence, but this held only for the youngest children. CONCLUSIONS: Height-for-age can be a useful indicator of recent changes in social and environmental effects on child health. The mother's influence may have buffered the negative impact of socioeconomic conditions on child growth.     

Associations between maternal feeding style and food intake of children with a higher risk for overweight

OBJECTIVE: The aim of this study is to examine the impact of different feeding strategies on the child's food intake as well as the effect and influence socio-economic status and weight have on the use of feeding strategies. METHODS: 219 mothers and their children between 3 and 6 years of age at risk for becoming overweight took part in this cross-sectional study. The participating mothers were recruited from inpatient-clinics and kindergartens with a lower socio-economic background. Besides demographic and weight data, which describe the child's risk for overweight, the mothers were asked for their use of feeding strategies and their child's food intake. RESULTS: Maternal feeding practices have an important impact (22.2-26.9% explained variance) on the child's food intake. There are three strategies (rewarding, child's control and pressure) which turned out to be significant predictors. Additionally, the child's weight, family income and educational level have an effect on the choice of feeding strategies and their impact on the child's food intake. CONCLUSIONS: The results are evidence of the influence of parental feeding practices on the child's food intake. Parent training in prevention and intervention of childhood obesity should include the discussion and modification of feeding practices.     

Quality of family context or sibling status? Influences on cognitive development

This study analyzes the influence of socioeconomic status, quality of family context and sibling status on cognitive development in a sample of 551 five-year-old children. The regression analyses confirmed the predictive value of socioeconomic status and quality of family context on cognitive development. The quality of family context mediates the relation between socioeconomic status and cognitive development. None of the variables relating to the sibling group showed a significant relationship with cognitive development.     

家庭社会经济状况与3岁以内儿童生长发育及营养状况的关系

目的 探究家庭社会经济状况(SES)与3岁以内儿童生长发育及营养状况的关系,为我国儿童预防保健提供科学依据。方法 数据源于2015年中国九市7岁以下儿童体格发育调查的西安地区数据。研究共纳入父/母亲文化程度、父/母亲职业和家庭年收入5项指标因子,构建了SES综合指标作为自变量。结局变量为身长、体重和评估的营养状况结局。调整儿童性别和月龄后,分别建立线性回归和Logistic回归模型,分析SES与身长体重和营养结局的关系。结果 研究共纳入3岁以内儿童12 017人,经评估营养不良者281人(2.3%),营养过剩者531人(4.4%)。调整儿童性别和月龄后,与低水平SES儿童相比,中等水平SES儿童身长增加0.32 cm(95%CI:0.16~0.47),发生营养过剩的风险降低20%(OR =0.80, 95%CI:0.65~0.98);高水平儿童身长增加0.77 cm(95%CI:0.61~0.92),体重增加0.06 kg(95%CI:0.006~0.12),发生营养过剩的风险降低33%(OR=0.67, 95%CI:0.53~0.83)。结论 较好的社会经济状况可能降低营养过剩的风险,有助于儿童的发育与营养健康。应改善家庭育儿环境,加强对低SES家庭的儿保宣教,提高儿童的健康水平。     

Determinants of early cognitive development: hierarchical analysis of a longitudinal study

The study describes the relationship between anthropometric status, socioeconomic conditions, and quality of home environment and child cognitive development in 320 children from 20 to 42 months of age, randomly selected from 20,000 households that represent the range of socioeconomic and environmental conditions in Salvador, Bahia, Northeast Brazil. The inclusion criterion was to be less than 42 months of age between January and July 1999. Child cognitive development was assessed using the Bayley Scales for Infant Development, and the Home Observation for Measurement of the Environment Inventory (HOME) was applied to assess quality of home environment. Anthropometric status was measured using the indicators weight/age and height/age ratios (z-scores), and socioeconomic data were collected through a standard questionnaire. Statistical analysis was conducted through univariate and hierarchical linear regression. Socioeconomic factors were found to have an indirect impact on early cognitive development mediated by the child's proximal environment factors, such as appropriate play materials and games available and school attendance. No independent association was seen between nutritional status and early cognitive development.     

Family social characteristics related to physical growth of young children.

Altogether 164 poor families who had children of normal and subnormal weight and height were studied in Bogota, Colombia. Physical growth was found to be positively associated with expenditure on food, sanitary conditions in the home, mother's age, birth interval between surviving children, level of parental newspaper reading, aspirations for children, and socioeconomic status. Physical growth was negatively associated with crowded living conditions and family size. Only mother's age, family size, spacing of births, and sanitary conditions were related to weight and height, independent of socioeconomic status. Food expenditure, crowding, parental newspaper reading, and aspirations for children all reflected the influence of socioeconomic status upon physical growth. The findings emphasized the importance of within-class social differences as they affect the physical growth of young children.     

Maternal education and child nutritional status in Bolivia: finding the links

This study models various pathways linking maternal education and child nutritional status in Bolivia, using a national sample of children. Pathways examined include socioeconomic status, health knowledge, modern attitudes towards health care, female autonomy, and reproductive behavior. The data come from the 1998 Bolivia Demographic and Health Survey. Logistic regression results suggest that socioeconomic factors are the most important pathways linking maternal education and child nutritional status, and that modern attitudes about health care also explain the impact of education. Health care knowledge accounts for less of the effect of maternal education on child nutritional status, with autonomy being the weakest pathway. Other pathways, such as reproductive behaviors, appear to influence nutritional status independent of maternal education. Overall, the pathways examined accounted for 60 percent of the effect of maternal education on child nutritional status.     

Risk factors to health in diabetic children: a prospective study from diagnosis

This study explored associations between health status and psychosocial, family, and demographic factors among 42 children with recently diagnosed diabetes mellitus. Health status was assessed using glycosylated hemoglobin (HbA1), a measure of the children's level of metabolic control. Four groups of variables were investigated as possibly relating to metabolic control: demographics, family social climate, child's self-concept, and compliance with the treatment regimen. Metabolic control was associated with race, number of parents in the home, family cohesion, and socioeconomic status. Multiple regression analysis indicated that children from black and single-parent families were at higher risk for poorer disease control and that this pattern persisted 2 and 3 years after diagnosis. These findings can help identify families that may benefit from more effective interventions involving social work practice.     

Giardia duodenalis infection: risk factors for children living in sub-standard settlements in Brazil

The objective of the present study was to characterize Giardia duodenalis infection among children living in sub-standard settlement areas in the municipality of Juiz de Fora, Minas Gerais State, Brazil. The cross-sectional epidemiological study included 590 children from 1 to 5 years of age. Data were collected from one child per selected family through home interviews with the parent or guardian and parasitological examination of stool samples. Thirty-one putative risk factors concerning family structure, socioeconomic status, and environmental factors were analyzed by multivariate logistic regression. Prevalence of G. duodenalis infection was 18% (106 children). Four potential risk factors were heavily associated with G. duodenalis infection: number of under-five children in the same household, index child's birth order, existence of a bathroom in the home, and drinking water source.     

Influence of family structure on health among youths with diabetes

Type 1 diabetes mellitus is a chronic metabolic disorder and is one of the most common chronic diseases in childhood. The study discussed in this article examined the extent to which family structure is significantly associated with health in youths with Type 1 diabetes. A convenience sample of 155 children with diabetes and their mothers completed face-to-face interviews; multiple regression analyses were conducted. Findings demonstrated that family structure remains a significant predictor of youths' health when statistically controlling for race, child's age, family socioeconomic status, and adherence. Social workers in outpatient medical settings are in a unique position to develop family-oriented strategies targeting this neglected area of primary care.     

Risk factors for malnutrition in Brazilian children: the role of social and environmental variables

The article reports the effects of several socioeconomic and environmental indicators on the nutritional status (stunting, underweight, and wasting) of a sample of 802 children aged 12-35.9 months in urban and rural areas of southern Brazil. Of the social variables studied, family income and father''s education level were the two risk factors that showed the strongest associations with nutritional status. The mother''s education level, employment status of the head of the family, number of siblings, and family''s ethnic background also showed some degree of association, but these were less significant when family income was included in the analysis. Environmental variables, particularly the type of housing, degree of crowding, and type of sewage disposal, were also strongly associated with malnutrition. The effects of having access to piped or treated water were only apparent on stunting and wasting.