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Blood lead (Pb) poisoning is a worldwide heath problem, especially in developing countries. As the largest developing country in the world, China faces severe health challenges, in particular the threat of blood Pb poisoning. In this study, the temporal trend of Chinese children's blood lead levels (BLLs) and blood lead poisoning incidence (BLPI) (percentage of BLL > 100 μg/L) and its influencing factors were investigated. We collected articles on children's BLLs published from 1997 to 2017 with sampling time from 1997 to 2015 by searching the databases of VIP Medical Information System (VMIS), China National Knowledge Infrastructure (CNKI) and Wanfang Data. After a rigorous investigation, 259 articles with eligible inclusion criteria were reviewed. Meanwhile, the data of Pb concentrations in the soil of 23 cities and the annual mean PM10 (particulate matter < 10 μm) concentrations of 24 provincial cities were collected. The temporal trend of children's BLLs and BLPIs could be divided into three stages: upward trend from 1997 to 2000, downward trend from 2001 to 2013, and upward trend from 2014 to 2015. The decline of BLLs from 2001 was primarily due to the phasing out of leaded gasoline since 2000 in China, while the descending air quality could explain the upward trend of BLLs in the period from 2014 to 2015. The correlation and regression analysis indicated that soil and air were two major pathways of Pb exposure for children in China. Although a noticeable decrease has been shown, the Chinese children's BLLs were still significantly higher than the levels of developed countries. We highly recommended that the critical value of blood Pb poisoning should be lowered to 50 μg/L in China. Guidelines on the prevention and management of blood Pb poisoning are needed in China. [ABSTRACT FROM AUTHOR]

A cross-sectional analysis of 33,942 schoolchildren at 6th grade (peri-urban New Taipei, N = 25,028; urban Taipei, N = 8914), representing >50% of children population of the age in Taipei metropolitan area, was examined for the disparity in overweight/obesity prevalence between urban and expanding peri-urban regions. Overweight/obese prevalence of schoolchildren at the age level is 30.4%. Peri-urban schoolchildren had higher overweight/obesity prevalence than urban peers (Girls: 26.0% vs 20.6%, P < 0.001; Boys: 37.1% vs 33.8%, P < 0.001). Children in both regions spent substantially more time on homework/reading than television viewing and computer use. Peri-urban children spent less time on homework/reading and more time on television and computer use than their urban counterparts (P < 0.001). Children with parental education category at “No College” were 54.8% in peri-urban area against 24.8% in urban area (P < 0.001). They were 1.0 cm shorter in height and ∼1.0 kg heavier in weight, and spent less time on homework/reading than those at “College” (P < 0.001). This is the first report presents a disparity in childhood overweight/obesity prevalence between peri-urban and urban places. Public efforts are needed to solve the childhood overweight/obesity problem secondary to social inequality in places at developing stages during urbanization. [ABSTRACT FROM AUTHOR]

This study, informed by phenomenology and ethnography, explores urban children’s relationship with trees in a garden camp context: what are trees for urban children? Studying Finnish 7- to 12-year-old children, the research employed triangulation: participant and non-participant observation methods with mixed data collection over the course of three years. Engaging in grounded theory analysis after an intermission, the study unites the theoretical constructs of affordance and connectedness to place. Based on empirical observations, this study provides a theoretical framework to clarify the phased process of how urban children’s connectedness to place is evolving. Exploitation of tree affordances during place-based play reflected connectedness to place; utilization of trees became more versatile over time. The results showed trees to be intriguing and multifaceted, satisfying many of the children’s private and social needs. Trees provided the materials, space and often purpose and contents for the actual play that could not have thrived without them. In addition, children learned to manage possible tree-related risks mainly from experience and through scaffolding with peers. Recommendations for supporting beneficial nature contact emphasize allowing child-directed, place-based play time and planning biodiverse, low-maintenance spaces with a wide variety of trees that will invite children to use green spaces according to their needs. [ABSTRACT FROM AUTHOR]

Background: Universal access to the School Breakfast Program (SBP) is intended to help low-income and food-insecure students overcome barriers to eating breakfast. However, SBP participation is often still low despite universal access. Further information is needed with regard to these children's breakfast behaviors, and in particular breakfast behaviors among youth from food-insecure families, to inform effective breakfast interventions.Objectives: The objective of this study was to examine breakfast behaviors among a large sample of urban students with universal access to the SBP and to identify differences in breakfast behaviors among children from food-secure compared with food-insecure households.Methods: A cross-sectional study of 821 fourth- through sixth-grade students and their parents from 16 schools was conducted. Students reported the foods/drinks selected and location of obtaining food/drink on the morning of data collection, parents reported household food security status using the 6-item Food Security Survey Module, and the school district provided SBP participation data during the fall semester of 2013. Multivariable linear regression models accounting for school-level clustering were used to examine differences in breakfast behaviors across 3 levels of household food security: food secure, low food secure, and very low food secure.Results: Students participated in the SBP 31.2% of possible days, with 13% never participating in the SBP. One-fifth (19.4%) of students purchased something from a corner store for breakfast, and 16.9% skipped breakfast. Forty-six percent of students were food insecure; few differences in breakfast behaviors were observed across levels of food security.Conclusions: Despite universal access to the SBP, participation in the SBP is low. Breakfast skipping and selection of foods of low nutritional quality in the morning are common, regardless of household food security status. Additional novel implementation of the SBP and addressing students' breakfast preferences may be necessary to further reduce barriers to students obtaining a free, healthful breakfast. This trial was registered at clinicaltrials.gov as NCT01924130. [ABSTRACT FROM AUTHOR]

Background Brain growth and structural organization occurs in stages beginning prenatally. Toxicants may impact neurodevelopment differently dependent upon exposure timing and fetal sex. Objectives We implemented innovative methodology to identify sensitive windows for the associations between prenatal particulate matter with diameter ≤ 2.5 μm (PM 2.5 ) and children's neurodevelopment. Methods We assessed 267 full-term urban children's prenatal daily PM 2.5 exposure using a validated satellite-based spatio-temporally resolved prediction model. Outcomes included IQ (WISC-IV), attention (omission errors [OEs], commission errors [CEs], hit reaction time [HRT], and HRT standard error [HRT-SE] on the Conners' CPT-II), and memory (general memory [GM] index and its components — verbal [VEM] and visual [VIM] memory, and attention-concentration [AC] indices on the WRAML-2) assessed at age 6.5 ± 0.98 years. To identify the role of exposure timing, we used distributed lag models to examine associations between weekly prenatal PM 2.5 exposure and neurodevelopment. Sex-specific associations were also examined. Results Mothers were primarily minorities (60% Hispanic, 25% black); 69% had ≤ 12 years of education. Adjusting for maternal age, education, race, and smoking, we found associations between higher PM 2.5 levels at 31–38 weeks with lower IQ, at 20–26 weeks gestation with increased OEs, at 32–36 weeks with slower HRT, and at 22–40 weeks with increased HRT-SE among boys, while significant associations were found in memory domains in girls (higher PM 2.5 exposure at 18–26 weeks with reduced VIM, at 12–20 weeks with reduced GM). Conclusions Increased PM 2.5 exposure in specific prenatal windows may be associated with poorer function across memory and attention domains with variable associations based on sex. Refined determination of time window- and sex-specific associations may enhance insight into underlying mechanisms and identification of vulnerable subgroups. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effectiveness of the Danger Rangers Fire Safety Curriculum in increasing the fire safety knowledge of low-income, minority children in an urban community setting. Methods Data was collected from child participants via teacher/researcher administered pre-, post-, and retention tests. A self-administered questionnaire was collected from parents pre- and post-intervention to assess fire/burn prevention practices. Paired t-tests were conducted to compare pre-, post-, and retention test mean scores by grade group. McNemar's test was used to determine if there was a change in parent-reported prevention practices following the intervention. Results The first/second grade group and the third grade group scored significantly higher on the post- and retention test as compared to the pre-test (p<0.0001 for all comparisons). There was no significant change in scores for the pre-k/k group after the intervention. There was a significant increase in 2 of 4 parent-reported fire/burn-related prevention practices after the intervention. Conclusion Fire safety knowledge improved among first to third grade children, but not among pre-kinder and kindergarten children who participated in the intervention. This study also showed that a program targeted towards children and delivered in a classroom setting has the potential to influence familial prevention practices by proxy. [ABSTRACT FROM AUTHOR]

We monitored 108 children ≤5 years on a 6-month basis for up to 5 years in a major urban setting. Samples (n ∼ 7000) included blood, urine, handwipes (interior, and after exterior playing), 6-day duplicate diet, drinking water, interior house and day care dust-fall accumulation using petri dishes, exterior dust-fall accumulation, exterior dust sweepings, paint, soil and urban air. The geometric mean blood Pb (PbB) was 2.1 μg/dL and blood Mn (MnB) was 10.0 μg/L. Following a path modelling approach, mixed model analyses for a fully adjusted model showed the strongest associations for PbB were with interior house dust and soil; for MnB there were no significant associations with any predictors. Predictor variables only explained 9% of the variance for Pb and 0.7% for Mn. Relationships between environmental measures and PbB in children are not straightforward; soil and dust sweepings contribute only about 1/5th of the amounts to PbB found in other studies. [Copyright &y& Elsevier]

Abstract: The urban–rural continuum provides unique contexts for development. Differences in access to resources and childrearing norms and practices in urban, suburban, and rural areas may be linked to disparities in early achievement. Yet, few studies examine associations between urbanicity and children''s early academic skills. Using nationally representative data from the Early Childhood Longitudinal Study, Birth Cohort (N ≈6050) this study examined differences in academic skills at kindergarten entry across large urban, small urban, suburban and rural areas. Additionally, it considered whether home environments and child care experiences explained disparities in early achievement. Results showed that children in large urban and rural areas entered kindergarten with less advanced academic skills than children in small urban areas and suburbs. Lower achievement for rural children was partly explained by less advantageous home environments and increased use of home-based, rather than center-based, preschool. Parents living in large urban areas had less knowledge of child development, which helped explain their children''s lower achievement. [Copyright &y& Elsevier]

Abstract: We examine the effects of Title I on school behavior, resources, and academic performance using a rich set of school finance and student-level achievement data from one large urban school district using a regression discontinuity design. We find that Title I eligibility raises Federal revenues of schools by about $460 per student. This is partially offset by decreases in revenues from state categorical aid grants, so that the net increase to schools is about $360 per student. We find no impact on overall school-level test scores, but also no impact among the subgroups of students most likely to be affected by Title I. A novel finding is that schools appear to respond to the incentives embedded in the Title I allocation process by manipulating the fraction of their students signed up for free lunch to secure more Federal funds. [Copyright &y& Elsevier]

Abstract: Objective: This study examined the association between maternal drug abuse history, maltreatment exposure, and functioning, in a clinical sample of young children seeking therapy for maltreatment. Methods: Data were collected on 91 children, mean age 5.3years (SD 1.0). The Preschool and Early Childhood Functional Assessment Scales (PECFAS) was used to measure functional impairment. A child maltreatment exposure (CME) score was developed based on maltreatment history. Data on maternal risk factors including maternal drug abuse (MDA) were obtained. Data were analyzed using descriptive statistics and regression modeling. Results: Approximately half (47.3%) of the children had a history of MDA. MDA history was associated with increased odds of neglect (OR=5.6, 95% CI=2.2–14.6) and abandonment (OR=3.3, 95% CI=1.3–8.3), and decreased odds of sexual abuse (OR=0.35, 95% CI=0.2–0.8). There were no statistically significant differences in CME scores for children with MDA history when compared to children without MDA history. Children with MDA history had an increased mean functional impairment score (mean 15 points; 95% CI=1.3–29.2) compared to children without MDA history. Following adjustment for maltreatment, no difference in impairment score was found. Conclusion: Although MDA history was associated with higher odds of neglect and abandonment, it was not associated with total CME or functional impairment. Adverse socio-environmental experiences associated with urban environments may confer a high risk of CME and functional impairment, irrespective of MDA history. Practice implications: In addition to maternal drug abuse, clinicians working with children need to identify other factors which could place the child at added risk for maltreatment. Further research is needed to better understand the role of adverse socio-environmental experiences on maltreatment and functional impairment in children. This study highlights the need for a multi-disciplinary approach to prevention and intervention programs needed to diminish adverse socio-environmental conditions prevalent in urban environments. [Copyright &y& Elsevier]

Abstract: Given enormous global challenges, alongside nurturing children''s creativity, professional creativity has perhaps never been more vital (). This paper considers how a small, qualitative, co-participative study in an inner city children''s centre, explored practitioner perspectives and practice related to creativity understood as possibility thinking. This research builds on previous studies that have documented possibility thinking and analyses the nature of possibility thinking manifest in child-initiated immersive play triggered by practitioner-placed provocations, and pedagogical strategies which foster this. [Copyright &y& Elsevier]

Abstract: Objective: The goal of this review was to investigate methodological differences in studies on the effects of aircraft or road-traffic noise on blood pressure (BP) of urban children, emphasizing the similarities and differences in blood pressure measurements. Methods: A literature search has identified eight peer-reviewed studies, four conference proceedings and one PhD thesis on the effects of aircraft or road-traffic noise on children''s blood pressure published in English in the last 30years. Most of the studies were cross-sectional, and four studies were longitudinal, with follow-up period from one to three years. The studies were analyzed according to the following methodological issues: study design, children''s characteristics, noise exposure assessment and blood pressure measurements. The effects of noise on systolic and diastolic pressure were presented in detail. Results: Studies on aircraft noise had more uniform methodology, indicating a slight tendency towards a positive relationship between aircraft noise exposure and BP in children. The studies on road-traffic noise were methodologically diverse, but compared to aircraft noise studies they showed a more uniform trend in the direction of a positive relationship with systolic BP. The time, place and number of BP measurements, as well as the devices and cuff sizes varied among the studies. Children''s age, gender, body composition and ethnicity, and socio-economic status remain the greatest source of diversity in BP values. Conclusions: The reviewed studies were methodologically diverse concerning noise exposure assessment, BP measurement, study design and control for confounders. In spite of this, they indicate a tendency toward positive association between noise exposure and children''s blood pressure. We recommended strategies that might help researchers adopt similar procedures when measuring BP in future field studies. [Copyright &y& Elsevier]

Background: Despite guidelines-defined care, inner-city children of low socioeconomic status have poor asthma control. Objective: This study evaluated time to achieve control, maintenance of control, and factors associated with well controlled asthma for pediatric patients receiving specialty-based asthma care in mobile asthma clinics designed to reduce barriers to delivering effective asthma care (the Breathmobile Program). Methods: Existing clinical data collected from January 1998 to June 2008 for 7822 pediatric patients with asthma (34,339 visits) enrolled in similarly structured mobile asthma programs across the United States evaluated the effect of asthma control on the reduction of asthma-related morbidity, time to achieve asthma control, maintenance of asthma control, and factors associated with well controlled asthma. Results: Comparison of pre and post year data for subjects enrolled in the program for at least 1 year revealed reductions in the percentage of patients reporting emergency department visits (mean, 66%), hospitalizations (mean, 84%), and missed school days ≥5/year (mean, 78%). Well controlled asthma was achieved by visit 3 for an estimated 80% of patients. Factors contributing to well controlled asthma include non-African American race, visit interval <90 days, and adherence to prescribed therapy. Conclusion: This study demonstrates the ability to achieve and maintain asthma control in high-risk populations in association with intensive, accessible, guidelines-defined care with close follow-up. [ABSTRACT FROM AUTHOR]

Abstract: This study utilized a multi-informant approach to investigate the concurrent association between peer victimization and functioning at school in a predominantly Latino sample of 135 children (55 boys; 80 girls) in the third, fourth, and fifth grades. The children attended elementary schools in economically distressed urban neighborhoods. Victimization by peers was associated with low grade point averages (GPA) and poor school engagement. Mediation analysis showed that school engagement explained the relation between peer victimization and GPA. Moderator analyses indicated that the negative association between peer victimization and school engagement was exacerbated for children with numerous friends in their classrooms. Additional moderator analyses revealed that the negative association between victimization and engagement was stronger for children with many aggressive friends. The results extend past research by investigating a mediator and moderators of the association between peer victimization and functioning at school in an understudied population. [Copyright &y& Elsevier]

Abstract: Using data from Birth to Twenty, a cohort of South African urban children, the current paper investigates the relationships between residential and school mobility and a set of educational outcomes. The findings provide some evidence of a positive association between changes in residence and numeracy and literacy scores, and school mobility was found to be associated with grade repetition, however, no relationship was observed between changes in school and competency in numeracy and literacy. The South African study provides a counter example to trends observed in higher-income countries, while highlighting that associations are likely to be context specific. [Copyright &y& Elsevier]

Abstract: The study examined whether characteristics of the urban physical environment are associated with child and maternal body mass index (BMI) in a sample of 3 year-old children and their mothers from 18 US cities (N=1997 dyads). BMI was determined based on measured height and weight. Characteristics of the interior and exterior physical environment, assessed and rated by trained interviewers, were related to child BMI at age 3 and to their mother''s BMI. Negative aspects of the physical environment were more strongly related to maternal BMI among whites than among African–Americans or Hispanics. [Copyright &y& Elsevier]

To explore the epidemiology of childhood electrocution in Bangladesh, a population-based cross-sectional survey was conducted between January and December 2003. Nationally representative data was collected from 171,366 rural and urban households, comprising of a total population of 819,429. The average incidence rate of non-fatal childhood electrocution was 53.2 per 100,000 population-year. The rate was found to be significantly higher (p =.000) among male children compared to the females which was 66.7 and 39.2 per 100,000 population-year, respectively. A significantly higher rate of electrocution was found in rural areas compared to urban (p =0.000). The average child death rate due to electrocution was 1.42 per 100,000 population-year. More than two-thirds of the total childhood electrocution took place at home and 69% electrocution cases were from a domestic source of electricity. Younger children, specifically males are more vulnerable to electrocution. Rural children are at higher risk compared to urban. Home is the most common place of childhood electrocution. A national strategy and prevention program is necessary to address morbidity and mortality of children due to electrocution. [Copyright &y& Elsevier]

Teachers' views and expectations of students directly impact student learning, and unless they are challenged during the preparation period, these views are unlikely to change. This study investigated how a group of prospective teachers explained the shift in their perspectives of low-income, urban youth as a result of participating in a service-learning project that explicitly attended to issues of status and processes of unlearning. The findings indicate that when fused with student voice work, service learning can help prospective teachers to uncover, examine, and revise their assumptions about students, particularly those whose backgrounds differ from their own. [Copyright &y& Elsevier]

Abstract: We consider young children''s construals of biological phenomena and the forces that shape them, using category-based induction task that demonstrated anthropocentric reasoning in young urban children. Follow-up studies (including our own) have questioned the generality of her results, but they have employed quite different procedures and either have not included urban children or, when urban samples were included, have failed to reproduce her original findings. In the present study of 4–10-year-olds from three cultural communities, our procedures followed Carey''s more closely and replicated her findings with young urban children. However, they yielded quite different results for young rural European American and young rural Native American children. These results underscore the importance of a complex interaction of culture and experience – including both day-to-day interactions with the natural world and sensitivity to the belief systems of the communities – in children''s reasoning about the natural world. [Copyright &y& Elsevier]

Objective: We used Glasgow's RE-AIM framework to evaluate the feasibility of a primary care-based intervention to decrease behaviors that place urban children at risk for obesity. Methods: During preventive visits of 2–5-year-olds between February 2006 and May 2007, parents completed a health behavior assessment. Primary care providers engaged parents in brief goal setting and referred them to a lifestyle counselor. Evaluation involved medical record review, interviews with staff and clinicians, and health behavior assessment via a pre- and post-intervention telephone survey. Results: Families reached by the intervention did not differ from families who were not. The intervention was adopted by 14 of 17 clinicians. The health assessment was implemented in 32% of preventive visits (N =354). Of those, goal setting by physicians occurred in 59%, with 55% referred to the lifestyle counselor. We were unable to demonstrate effectiveness to change adult or child nutrition or physical activity, as complete data were available for only 34 families. Conclusion: Goal setting with referral for more intensive lifestyle counseling for obesity prevention in high risk families is feasible and acceptable in primary care. Practice implications: Patient educators can be integrated into primary care to achieve preventive care goals. [Copyright &y& Elsevier]

Abstract: Physical activity has a great influence on our health. Because of the environmental prerequisites of physical activity and health it would be important to explore what children think of this relationship. Therefore, this paper aims to highlight the connection among environment/urban planning and physical activity and the importance of them for health. The primary goal of the present study was to determine beliefs and interconnections between environment and regular physical activity between Grade 4 and Grade 5 children living in different urban settings. Subjects included young children aged 9–11 (N =448) from six primary schools in Hungary representing three residential location types (capital city, medium-sized and small towns). Interconnections among the children''s environment, health/illness and physical activity were assessed through a questionnaire based upon the ‘draw-and-write’ technique. Our findings showed a close connection between urban children''s images of physical activity and the environment. Children''s mentions of sports equipment, place, or institution suitable for physical activity were frequently in connection with the word ‘environment’. The children''s drawings and written answers that were analyzed in this study support, within each type of the residential location examined, that there is an opportunity to engage in satisfactory leisure time physical activity. [Copyright &y& Elsevier]

Abstract: We present the results of active case ascertainment of fetal alcohol syndrome (FAS). This study included a sample of urban schoolchildren attending 1st to 4th grade elementary school and their mothers. Out of 912 mothers, 575 (63.04%) participated in the interview. Prenatal alcohol consumption was admitted by 15.47% and binge drinking by 3.13% of interviewed mothers. We evaluated 466 (51.09%) schoolchildren for signs of FAS or partial fetal alcohol syndrome (PFAS) using revised Institute of Medicine (IOM) diagnostic criteria. Nineteen students had features consistent with FAS or PFAS. The observed prevalence of FAS is 3 children and of PFAS is 16 children among 466 students, based on 51% participation rate. The estimated prevalence of FAS is 6.44/1000, of PFAS 34.33/1000 and overall prevalence of FAS/PFAS 40.77/1000. This is the first study of FAS prevalence in Croatia and as far as we are aware the second study in Europe. [Copyright &y& Elsevier]

Objective: To assess mother-child agreement on the child's past food exposure, and factors affecting response discrepancy. Methods: Twelve- to 14-year-old children and their mothers (n = 78) in an urban community, a rural community, and 2 orthodontic clinics completed a 69-item food questionnaire to determine mother-child level of agreement on the child's past consumption frequency; response discrepancies; the frequencies that the mother cooked for and ate together with her child; food types; mother-child pair effect; and food item effect. Results: Sixty-eight percent of food items had moderate to good agreement (Kqw ⩾ 0.41). Rural pairs had lower odds of producing response discrepancy (odds ratio = 0.55). Variances of the mother-child pair and food item random effects were 0.87 and 0.08, respectively. Conclusions and Implications: The child's past food exposure recall by the mother and the child had moderate to good agreement, especially among rural mother-child pairs. Mother-child disagreement was not affected by the food items. [ABSTRACT FROM AUTHOR]

Abstract: The objective of this study was to describe and compare the dietary variety, diversity, and origins of complementary foods given to urban and rural Guatemalan infants in the second semester of life. Dietary intake from a total of 128 infants of both sexes, aged 6.0 to 12.0 months on admission, from a low-income district of Guatemala City and a rural Mayan village was collected by means of 3 nonconsecutive 24-hour quantitative intake recalls and breast-feeding histories. We hypothesized that rural/urban, age, and sex differences would occur with respect to dietary variety and diversity scores and descriptive features at 7 levels, that is, animal or plant origin (animal, plant, both, or water); solids or semisolids vs soups and stews vs liquids; infant vs family foods; modern vs traditional foods; processed vs nonprocessed foods; commercial vs noncommercial foods; and fortified vs nonfortified foods. Overall dietary variety and diversity scores did not differ significantly between sampling areas or between sexes. Infants aged 9 to 12 months had a higher dietary variety and diversity than infants aged 6 to 9 months. Plant sources constituted a large part of the diet in both areas. Foods prepared specifically for infants, rather than for the household, were not common, although more common in the urban area than in the rural area. Commercial, processed, and fortified foods were commonly consumed in both settings. It can be concluded that although no geographical differences were seen in dietary variety or diversity, distinctions between types of selected and consumed foods were observed. [Copyright &y& Elsevier]

Abstract: Health literacy (HL) affects adult asthma management, yet less is known about how parent HL affects child asthma care. Objective: To examine associations between parent HL and measures related to child asthma. Methods: Parents of 499 school-age urban children with persistent asthma in Rochester, New York completed home interviews. Measures: the Rapid Estimate of Adult Literacy in Medicine (REALM) for parent HL; National Heart Lung and Blood Institute (NHLBI) criteria for asthma severity, and validated measures of asthma knowledge, beliefs, and experiences. Analyses: bivariate and multivariate analyses of associations between parent HL measures related to child asthma. Results: Response rate: 72%, mean child age: 7.0 years. Thirty-two percent had a Hispanic parent; 88% had public insurance. Thirty-three percent had a parent with limited HL. Low parent HL was independently associated with greater parent worry, parent perception of greater asthma burden, and lower parent-reported quality of life. Measures of health care use (e.g., emergency care and preventive medicines) were not associated with parent HL. Conclusions: Parents with limited HL worried more and perceived greater overall burden from the child''s asthma, even though reported health care use did not vary. Practice implications: Improved parent understanding and provider-parent communication about child asthma could reduce parent-perceived asthma burden, alleviate parent worry, and improve parent quality of life. [Copyright &y& Elsevier]

Objective: To assess knowledge and attitudes about infertility through a survey. Design: Descriptive study with stratified random sampling. Setting: Eighteen high schools were selected in Toronto, Ontario, Canada. Patient(s): Seven hundred seventy-two students participated in the study. The mean age of students was 17.5 ± 0.98 years. Females were 49.02% (n = 377) of the sample. The sample was ethnically diverse, consisting of >13 groups. Intervention(s): None. Main Outcome Measure(s): The main outcome was infertility knowledge and attitudes. Secondary analysis compared gender and socioeconomic status. Result(s): The majority (608; 79%) of high school students were familiar with the term infertility (95% confidence interval: 76%, 82%). More than 94% did not know that chlamydia or gonorrhea could lead to infertility. Seventy percent felt that protecting their fertility was important to them, with significantly more females feeling this way. There was a higher proportion of students from schools with low socioeconomic status who gave incorrect answers to knowledge-related questions and were unaware of the association between sexually transmitted infections and infertility. Conclusion(s): Although the majority of students value their fertility, knowledge about preventable factors causing infertility was limited. Increased efforts are needed to educate students on factors that may affect their fertility. [Copyright &y& Elsevier]

Objective: To prospectively study the epidemiology and antibiotic resistance of Haemophilus infuenzae isolates from invasive infections in children.Methods: Children (<5years) with pneumonia, meningitis and septicemia from three hospitals in Dhaka, Bangladesh were enrolled (1999-2003); clinical and laboratory data, and blood for cultures were collected. Cerebrospinal fluid (CSF) of meningitis cases was analyzed (Gram stain, culture and biochemical tests). Hib antigen was detected by latex agglutination (LA) in culture-negative pyogenic CSF and PCR was done for bexA gene in culture- and LA-negative pyogenic CSF. Antibiotic susceptibility was determined by E-Tests and beta-lactamase by nitrocefin stick.Results: Seventy-three cases of H. influenzae infections (46 of 293 meningitis cases, 25 of 1493 pneumonia cases, 2 of 48 septicemia cases) were detected; 63%, 34% and 3% of them had meningitis, pneumonia and septicemia respectively. H. influenzae type b (Hib) caused infections in 80.8% of cases (60.3% meningitis, 20.5% pneumonia). Most (86%) infections clustered in 4-12month infants. The case-fatality in pneumonia was 8% compared to 19% in meningitis. H. influenzae isolates from pneumonia and meningitis children were equally resistant to antibiotics (46% vs 43%). Of 10 drugs tested, isolates were resistant to ampicillin (31%), chloramphenicol (42%), trimethoprim-sulfamethoxazole (44%) and azithromycin (1.4%). Multidrug-resistant (MDR) strains were equally prevalent in Hib (31%) and non-b-type (29%) isolates, and in pneumonia (31%) and meningitis (34%) cases. None was resistant to amoxicillin-clavulanate, ceftriaxone, ciprofloxacin, levofloxacin, moxifloxacin, and gatifloxacin. Of all H. influenzae infections, 40%, 4.4% and 100% of pneumonia, meningitis and septicemia cases were caused by other serotypes or non-typeable strains. All ampicillin-resistant-strains produced beta-lactamase without detection of beta-lactamase-negative-ampicillin-resistant (BLNAR) strains.Conclusion: Hib is a leading cause of invasive bacterial infections in infants. Multidrug-resistant H. influenzae is common and requires amoxicillin-clavulanate, ceftriaxone or azithromycin as empirical therapy with specific recommendation for use of ceftriaxone for treatment of meningitis particularly MDR cases. New fluoroquinolines has potential utility. An effective national Hib vaccination programme is essential in Bangladesh although non-Hib infections will remain an issue. [ABSTRACT FROM AUTHOR]

Abstract: On average, child health outcomes are better in urban than in rural areas of developing countries. Understanding the nature and the causes of this rural–urban disparity is essential in contemplating the health consequences of the rapid urbanization taking place throughout the developing world and in targeting resources appropriately to raise population health. Using micro-data on child health taken from the most recent Demographic and Health Surveys for 47 developing countries, the purpose of this paper is threefold. First, we document the magnitude of rural–urban disparities in child nutritional status and under-5 mortality across all 47 developing countries. Second, we adjust these disparities for differences in population characteristics across urban and rural settings. Third, we examine rural–urban differences in the degree of socioeconomic inequality in these health outcomes. The results demonstrate that there are considerable rural–urban differences in mean child health outcomes in the entire developing world. The rural–urban gap in stunting does not entirely mirror the gap in under-5 mortality. The most striking difference between the two is in the Latin American and Caribbean region, where the gap in growth stunting is more than 1.5 times higher than that in mortality. On average, the rural–urban risk ratios of stunting and under-5 mortality fall by, respectively, 53% and 59% after controlling for household wealth. Controlling thereafter for socio-demographic factors reduces the risk ratios by another 22% and 25%. We confirm earlier findings of higher socioeconomic inequality in stunting in urban areas and demonstrate that this also holds for under-5 mortality. In a considerable number of countries, the urban poor actually have higher rates of stunting and mortality than their rural counterparts. The findings imply that there is a need for programs that target the urban poor, and that this is becoming more necessary as the size of the urban population grows. [Copyright &y& Elsevier]

Abstract: The study goals were to determine the need for mental health services and the factors that best predicted receipt of services in a sample of urban, primarily minority children. A sample of 339 children and their caretakers (220 maltreated and 109 comparison) completed multiple measures of functioning and service use. The analysis found significantly different rates of needs and services in the two groups. While 55.3% of the maltreated children met the need for services, only 26.6% of the comparison children did. In the maltreated group, 62.2% of those meeting the need received services while 0% of the comparison children did. The logistic regression analysis found that being a child welfare client was the best predictor of receiving services. Also predicting service receipt was the relationship of the caretaker to the child (with relative caregivers more likely to receive services than biological parents) and the Total Problem score on the Child Behavior Checklist. Race/ethnicity did not predict service receipt. Type of abuse was not a predictor. Implications of the findings are discussed. [Copyright &y& Elsevier]

Abstract: For long now, the urban child has been considered to be more likely than his/her rural counterpart in being able to realize the dream of fully participating in school. This observation has mainly been attributed to what is commonly known as the “urban advantage”. This “urban advantage” is associated with increased access to facilities such as schools in urban areas. Recent work documenting population health in urban and rural areas has however begun to suggest that some sections of the urban population do not benefit from the “urban advantage”. For example, a child in the slums of Nairobi is more likely to suffer from diarrhea than a child in rural Kenya. In addition, a child from the richest household in the slums is more likely to suffer from diarrhea than a child from the poorest family in rural Kenya. This paper explores patterns of school enrollment comparing urban slum, urban non-slum and rural children. The paper uses data from the Kenya Demographic and Health Survey (KDHS) for 1993, 1998 and 2003. A contrast with school enrollment in Nairobi slums is done using the KDHS-type Nairobi Cross Sectional Slum Survey for 2000. Data from focus group discussions collected in the slums of Nairobi provide the context for discussion. The results suggest that school enrollment is higher in urban non-slum than in urban slum areas, and is higher in slums than in rural areas at younger ages. However, this is only true up to age 9 for females and 11 for males, from which school enrollment for slum children declines and the rate of decline is faster than among their rural counterparts. The corresponding ages at which the enrollment among the rural children begins to visibly decline are 13 years for males and 14 years for females. Factors contributing to these results point to the poor quality of primary schools in slums, limited access to secondary school for slum children, increased vulnerability to coercion into sexual activity and other ills that hinder school participation, disabling environment at home and increased child labor. [Copyright &y& Elsevier]

Abstract: To claim that young children''s biological thought is anthropocentric or that their induction depends on similarity rather than categories is to overlook the role of experience in reasoning. We tested four groups of 4-year-olds differing in two aspects of exposure to biological information: (a) their direct experience with nature (urban versus rural) and (b) biological expertise of their parents (expert biologists versus laypeople). We used a modified version of a novel feature projection task—in which projections are made from humans, mammals and insects to an array of nine targets representing various ontological kinds. Children''s exposure to biology had consequences on their patterns of induction. There was an effect of parents’ expertise: laypeople''s children''s projections were based on similarity, while experts’ children''s projections were based on the category animal. There was also an effect of direct experience: rural children were more restricted in their responses than were urban children. Although we found asymmetries in projections between humans and animals, humans were not a better source of knowledge about animates than were mammals or insects. These results show that the early emergence of domain specific biological thought and the use of biological categories in induction are highly contingent on children''s experience. [Copyright &y& Elsevier]

Abstract: Sixty-four 8-year-old boys and girls from urban and rural settings and representing different races and socioeconomic status backgrounds responded to questions about the nature, causes, justification, and alleviation of poverty. Much of what the children said indicated that they had not yet internalized prevailing adult norms and values about the poor in our society. A substantial proportion spoke in ways suggesting forces apart from the individual as causing poverty. Nearly all believed that poverty was not fair. Justifications offered by the children included disavowing economic inequality, or speaking in terms of basic needs or what should or ought to be. A majority mentioned philanthropy or societal change as a way to end poverty. Findings also lend support to the claim of social representations theory that concepts vary as a function of social factors. Future research should employ a design that acknowledges interacting variables to investigate systems of meaning in children''s understandings about poverty. [Copyright &y& Elsevier]

Abstract: The purpose of this study was to test the hypothesis that quality improvements in early childhood centers experience diminishing returns as the quality of the classroom rises with regards to concurrent socio-emotional outcomes. This hypothesis lies at the core of Scarr''s argument that public policy should concentrate on improving low quality settings rather than improving settings that already have acceptable quality. The study detected sizeable effect sizes linking process quality in the good to excellent range with reduction of existing socio-emotional risk factors (d =0.51) and prevention of the emergence of new socio-emotional risk factors (d =−0.41). These effect sizes are substantially larger than those reported by other studies investigating quality environments in the poor to good quality range (d =0.16), and larger than Durlak and Wells meta-analytic effect size for universal preventive interventions (d =0.35). Therefore, the hypothesis that as quality increases the benefits for children increase but at a diminishing rate was rejected for concurrent socio-emotional outcomes in urban populations. [Copyright &y& Elsevier]

This study assessed the development of 4-5-year-old children in an urban Low-income community in Sri Lanka, with the aim of investigating their readiness for format education. A modified Denver developmental screening test was used to determine the presence of age-appropriate motor, cognitive (including language) and social skills in 295 children. Of these children, 17.8% were unable to perform more than 50% of the tasks correctly. Children with motor problems were more Likely to have difficulties with cognitive tasks than children without motor problems. Children who attended preschool did significantly better in most tasks compared with those who did not. The Level of maternal education did not show a direct association with the competencies of the children. This assessment schedule can be used as a quick screening method in the community for early recognition of children with the potential for teaming problems in school. [ABSTRACT FROM AUTHOR]

Background: Both being overweight and exposure to indoor pollutants, which have been associated with worse health of asthmatic patients, are common in urban minority populations. Whether being overweight is a risk factor for the effects of indoor pollutant exposure on asthma health is unknown. Objectives: We sought to examine the effect of weight on the relationship between indoor pollutant exposure and asthma health in urban minority children. Methods: One hundred forty-eight children (age, 5-17 years) with persistent asthma were followed for 1 year. Asthma symptoms, health care use, lung function, pulmonary inflammation, and indoor pollutants were assessed every 3 months. Weight category was based on body mass index percentile. Results: Participants were predominantly African American (91%) and had public health insurance (85%). Four percent were underweight, 52% were normal weight, 16% were overweight, and 28% were obese. Overweight or obese participants had more symptoms associated with exposure to fine particulate matter measuring less than 2.5 μm in diameter (PM2.5) than normal-weight participants across a range of asthma symptoms. Overweight or obese participants also had more asthma symptoms associated with nitrogen dioxide (NO2) exposure than normal-weight participants, although this was not observed across all types of asthma symptoms. Weight did not affect the relationship between exposure to coarse particulate matter measuring between 2.5 and 10 μm in diameter and asthma symptoms. Relationships between indoor pollutant exposure and health care use, lung function, or pulmonary inflammation did not differ by weight. Conclusion: Being overweight or obese can increase susceptibility to indoor PM2.5 and NO2 in urban children with asthma. Interventions aimed at weight loss might reduce asthma symptom responses to PM2.5 and NO2, and interventions aimed at reducing indoor pollutant levels might be particularly beneficial in overweight children. [Copyright &y& Elsevier]

Background: The current epidemic of asthma and atopy has been explained by alterations in immune responses related to reduction in childhood infections. However, the findings of epidemiologic studies investigating the association between infection with atopy and asthma have been inconsistent. Objective: We sought to investigate the effect of single or multiple infections (pathogen burden) on atopy and wheeze in urban children from Latin America. Methods: Specific IgE against aeroallergens (sIgE) and skin prick test (SPT) reactivity for the most common local allergens were measured in 1128 children aged 4 to 11 years. Data on wheezing and potential confounders were collected by questionnaire. Infections by 8 pathogens were assessed by using serology and stool examination. Associations of wheeze and atopic outcomes with single and multiple infections were analyzed by means of logistic regression. Results: Negative results for Toxoplasma gondii were associated with a higher prevalence of sIgE (≥0.70 kU/L), whereas negative results for Ascaris lumbricoides, T gondii, herpes simplex virus, and EBV were associated with a higher prevalence of SPT reactivity. Children with 3 or fewer infection markers had a higher prevalence of sIgE and SPT reactivity compared with those with 4 or more infection markers. However, isolated infections or pathogen burden were not associated with the prevalence of atopic or nonatopic wheeze. Conclusion: The findings provide support for the idea that the hygiene hypothesis is operating in an urban Latin American context, but its expression is thus far restricted to the atopic status of patients and not the perceived asthma symptoms. [ABSTRACT FROM AUTHOR]

Background: Independent of current socioeconomic status (SES), past maternal SES might influence asthma outcomes in children. Objective: We examined associations among the mother’s SES in the first 10 years of her life (maternal childhood SES), increased cord blood IgE levels (upper 20% [1.37 IU/mL]), and repeated wheeze (≥2 episodes by age 2 years) in an urban pregnancy cohort (n = 510). Methods: Data on sociodemographics, discrimination, financial strain, community violence, interpersonal trauma, and other negative events were obtained prenatally. Prenatal household dust was assayed for cockroach and murine allergens, and traffic-related air pollution was estimated by using spatiotemporal land-use regression. Maternal childhood SES was defined by parental home ownership (birth to 10 years). Maternally reported child wheeze was ascertained at 3-month intervals from birth. Using structural equation models, we examined whether outcomes were dependent on maternal childhood SES directly versus indirect relationships operating through (1) cumulative SES-related adversities, (2) the mother’s socioeconomic trajectory (adult SES), and (3) current prenatal environmental exposures. Results: Mothers were largely Hispanic (60%) or black (28%), 37% had not completed high school, and 56% reported parental home ownership. When associations between low maternal childhood SES and repeated wheeze were examined, there were significant indirect effects operating through adult SES and prenatal cumulative stress (β = 0.28, P = .003) and pollution (β = 0.24, P = .004; P value for total indirect effects ≤ .04 for both pathways). Low maternal childhood SES was directly related to increased cord blood IgE levels (β = 0.21, P = .003). Maternal cumulative adversity (interpersonal trauma) was also associated with increased cord blood IgE levels (β = 0.19, P = .01), although this did not explain maternal childhood SES effects. Conclusion: Lower maternal childhood SES was associated with increased cord blood IgE levels and repeated wheeze through both direct and indirect effects, providing new insights into the role of social inequalities as determinants of childhood respiratory risk. [Copyright &y& Elsevier]

Purpose: To determine the age-specific prevalence of refractive errors in white and African-American preschool children. Design: The Baltimore Pediatric Eye Disease Study is a population-based evaluation of the prevalence of ocular disorders in children aged 6 to 71 months in Baltimore, Maryland. Participants: Among 4132 children identified, 3990 eligible children (97%) were enrolled and 2546 children (62%) were examined. Methods: Cycloplegic autorefraction was attempted in all children with the use of a Nikon Retinomax K-Plus 2 (Nikon Corporation, Tokyo, Japan). If a reliable autorefraction could not be obtained after 3 attempts, cycloplegic streak retinoscopy was performed. Main Outcome Measures: Mean spherical equivalent (SE) refractive error, astigmatism, and prevalence of higher refractive errors among African-American and white children. Results: The mean SE of right eyes was +1.49 diopters (D) (standard deviation [SD] = 1.23) in white children and +0.71 D (SD = 1.35) in African-American children (mean difference of 0.78 D; 95% confidence interval [CI], 0.67–0.89). Mean SE refractive error did not decline with age in either group. The prevalence of myopia of 1.00 D or more in the eye with the lesser refractive error was 0.7% in white children and 5.5% in African-American children (relative risk [RR], 8.01; 95% CI, 3.70–17.35). The prevalence of hyperopia of +3 D or more in the eye with the lesser refractive error was 8.9% in white children and 4.4% in African-American children (RR, 0.49; 95% CI, 0.35–0.68). The prevalence of emmetropia (<−1.00 D to <+1.00 D) was 35.6% in white children and 58.0% in African-American children (RR, 1.64; 95% CI, 1.49–1.80). On the basis of published prescribing guidelines, 5.1% of the children would have benefited from spectacle correction. However, only 1.3% had been prescribed correction. Conclusions: Significant refractive errors are uncommon in this population of urban preschool children. There was no evidence for a myopic shift over this age range in this cross-sectional study. A small proportion of preschool children would likely benefit from refractive correction, but few have had this prescribed. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Purpose: Studies of inner-city asthmatic children have shown significant regional variation in dust allergen exposures. The home environment of asthmatic children in the Gulf South region of the U.S. has not been characterized. This study describes indoor dust allergen levels and characteristics of asthmatic children in New Orleans and explores regional variability in dust allergen exposure. Methods: Data were used from baseline home visits of children in the New Orleans Healthy Homes Initiative. Interview, visual observation and environmental dust sampling data of 86 children between 4–17 years of age were analyzed. Results: Seventy-seven percent of households had moderate (> 2.0–9.9 μg/g) or high (≥10.0 μg/g) levels of either Der p 1 or Der f 1 dust mite allergen and 56.6% had high (> 2.0–8.0 U/g) or very high (> 8.0 U/g) levels of cockroach allergen (Bla g 1). The prevalence of high (>10 μg/g) levels of dog (Can f 1) allergen was 25.3% and few households (4.8%) had high cat allergen (Fel d 1) levels (>8.0 μg/g). Households with average humidity levels > 50% were three times more likely to have elevated dust mite levels (odds ratio = 3.2; 95% CI =1.1, 9.3; p=0.03). Home ownership and education level was associated with roach and dust mite allergen levels. Conclusions: Our findings reinforce evidence of regional variability in dust allergen exposure levels. Children living in the Gulf South may be exposed to a greater number of allergens at levels known to cause sensitization than in other regions of the country. [Copyright &y& Elsevier]