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Many women experience depressive symptoms after birth, and rates among African Americans are as high as 40 percent. Spirituality and religiosity are valued in African American communities, but their relevance to new mothers has not been empirically tested. We examined effects of religiosity and spirituality on trajectories of depressive symptoms during the year following childbirth. Data were collected by the Eunice Kennedy Shriver NICHD Community and Child Health Network (CCHN) focused on maternal-child health disparities. The sample consisted of 702 low SES African American predominantly Christian women. Participants were interviewed in their homes throughout the year following a birth. Spirituality and religiosity each independently predicted changes in depressive symptoms with low levels predicting increases over time. Effects of religiosity were mediated by a woman's spirituality. Religiosity and spirituality functioned as significant, interrelated protective factors in this study which provides novel insight about lower income African American women following birth.

The Abecedarian Approach is an early intervention and contains a broad-spectrum adult/child curriculum. The Approach has been studied in three longitudinal randomized controlled trials in the USA, starting in 1972 and continuing today. Recent research studies in multiple countries have examined the Abecedarian Approach during the first three years of life. The collective findings from these studies lead to the conclusion that human development is malleable, especially in the years before school entry, and that high-quality early intervention exerts positive, early, and long-lasting influences on human development, including social development and mental health.

Does early exposure to cognitive and linguistic stimulation impact brain structure? Or do genetic predispositions account for the co-occurrence of certain neuroanatomical phenotypes and a tendency to engage children in cognitively stimulating activities? Low socioeconomic status infants were randomized to either 5 years of cognitively and linguistically stimulating center-based care or a comparison condition. The intervention resulted in large and statistically significant changes in brain structure measured in midlife, particularly for male individuals. These findings are the first to extend the large literature on cognitive enrichment effects on animal brains to humans, and to demonstrate the effects of uniquely human features such as linguistic stimulation., (© 2021 Massachusetts Institute of Technology. Published under a Creative Commons Attribution 4.0 International (CC BY 4.0) license.)

Objectives: Dramatic increases in opioid and drug overdose mortality have occurred in the United States (US) over the past two decades. To address this national public health crisis and identify gaps in the literature, we analyzed recent empirical trends in US drug overdose mortality by key social determinants and conducted a selective review of the recent literature on the magnitude of the opioid crisis facing different racial/ethnic, socioeconomic, and rural-urban segments of the US population., Methods: We used the 1999-2017 mortality data from the US National Vital Statistics System to analyze trends in drug overdose mortality by race/ethnicity, age, and geographic area. Log-linear regression was used to model mortality trends. Using various key words and their combinations, we searched PubMed and Google Scholar for select peer-reviewed journal articles and government reports published on the opioid epidemic between 2010 and 2018., Results: Our original analysis and review indicate marked increases in drug overdose mortality overall and by race/ethnicity and geographic regions, with adolescents and young adults experiencing steep increases in mortality between 1999 and 2017. Our selective search yielded 405 articles, of which 39 publications were selected for detailed review. Suicide mortality from drug overdose among teens aged 12-19 increased consistently between 2009 and 2017, particularly among teen girls. The rise of efficient global supply chains has increased opioid prescription use and undoubtedly contributed to the opioid epidemic. Many other important contributing factors to the epidemic include lack of education and economic opportunities, poor working conditions, and low social capital in disadvantaged communities., Conclusions and Global Health Implications: Our analysis and review indicate substantial disparities in drug overdoses and related mortality, pain management, and treatment outcomes according to social determinants. Increases in drug overdoses and resultant mortality are not only unique to the US, but have also been observed in other industrialized countries. Healthcare systems, community leaders, and policymakers addressing the opioid epidemic should focus on upstream structural factors including education, economic opportunity, social cohesion, racial/ethnic disadvantage, geographic isolation, and life satisfaction., Competing Interests: Conflicts of Interest: The authors declare that there are no conflicts of interest., (Copyright: © 2019 Singh et al.)

Objectives: This study describes key population health concepts and examines major empirical trends in US health and healthcare inequalities from 1935 to 2016 according to important social determinants such as race/ethnicity, education, income, poverty, area deprivation, unemployment, housing, rural-urban residence, and geographic location., Methods: Long-term trend data from the National Vital Statistics System, National Health Interview Survey, National Survey of Children's Health, American Community Survey, and Behavioral Risk Factor Surveillance System were used to examine racial/ethnic, socioeconomic, rural-urban, and geographic inequalities in health and health care. Life tables, age-adjusted rates, prevalence, and risk ratios were used to examine health differentials, which were tested for statistical significance at the 0.05 level., Results: Life expectancy of Americans increased from 69.7 years in 1950 to 78.8 years in 2015. However, despite the overall improvement, substantial gender and racial/ethnic disparities remained. In 2015, life expectancy was highest for Asian/Pacific Islanders (87.7 years) and lowest for African-Americans (75.7 years). Life expectancy was lower in rural areas and varied from 74.5 years for men in rural areas to 82.4 years for women in large metro areas, with rural-urban disparities increasing during the 1990-2014 time period. Infant mortality rates declined dramatically during the past eight decades. However, racial disparities widened over time; in 2015, black infants had 2.3 times higher mortality than white infants (11.4 vs. 4.9 per 1,000 live births). Infant and child mortality was markedly higher in rural areas and poor communities. Black infants and children in poor, rural communities had nearly three times higher mortality rate compared to those in affluent, rural areas. Racial/ethnic, socioeconomic, and geographic disparities were particularly marked in mortality and/or morbidity from cardiovascular disease, cancer, diabetes, COPD, HIV/AIDS, homicide, psychological distress, hypertension, smoking, obesity, and access to quality health care., Conclusions and Global Health Implications: Despite the overall health improvement, significant social disparities remain in a number of health indicators, most notably in life expectancy and infant mortality. Marked disparities in various health outcomes indicate the underlying significance of social determinants in disease prevention and health promotion and necessitate systematic and continued monitoring of health inequalities according to social factors. A multi-sectoral approach is needed to tackle persistent and widening health inequalities among Americans., Competing Interests: Conflicts of Interest: The authors declare that they have no conflicts of interest. Financial Disclosure: None to report. Ethics Approval: All analyses were conducted using public-use data and were thus exempt from the institutional review board (IRB) approval.

The extent to which early educational intervention, early cumulative risk, and the early home environment were associated with young adult outcomes was investigated in a sample of 139 young adults (age 21) from high-risk families enrolled in randomized trials of early intervention. Positive effects of treatment were found for education attainment, attending college, and skilled employment; negative effects of risk were found for education attainment, graduating high school, being employed, and avoiding teen parenthood. The home mediated the effects of risk for graduating high school, but not being employed for teen parenthood. Evidence for moderated mediation was found for educational attainment; the home mediated the association between risk and educational attainment for the control group, but not the treated group.

Objectives: Two factors were considered as predictors of children's risk for unintentional injury: (a) children's temperamentally difficult behavior patterns and (b) parenting. Along with hypotheses to replicate previous univariate effects, it was hypothesized that active, involved parents with sufficient time resources might reduce injury risk among temperamentally at-risk children., Methods: Study 1 used a retrospective design with a diverse sample of over 10,000 5-year-olds. Study 2 replicated Study 1 using a prospective design and behavioral data from a sample of over 1,000 children followed from 6 to 36 months of age., Results: In Study 1, male gender, child hyperactivity, and family poverty predicted injury in a univariate manner. In Study 2, male gender and lack of positive parenting predicted injury in a univariate manner. Interaction effects also emerged: in Study 1 the interaction between child hyperactivity and parental time resources protected children from injury, and in Study 2 the interaction between child's difficult temperament and positive parenting protected children from injury., Conclusions: Children at increased risk for injury, i.e., those with hyperactive and difficult behavior patterns, might be protected in the environment of positive parenting. Theoretically, results suggest that researchers should consider Temperament x Environment interactions along with univariate predictors of outcome behavior. From an applied perspective, results have implications for the design of injury prevention campaigns: Parents who spend positive time with temperamentally difficult children might protect them from injury.

This longitudinal study of 161 African American children from low-income families examined multiple influences, including early childhood interventions and characteristics of the child and family, on longitudinal patterns of children's cognitive performance measured between 6 months and 8 years of age. Results indicate that more optimal patterns of cognitive development were associated with intensive early educational child care, responsive stimulating care at home, and higher maternal IQ. In accordance with a general systems model, analyses also suggested that child care experiences were related to better cognitive performance in part through enhancing the infant's responsiveness to his or her environment. Maternal IQ had both a direct effect on cognitive performance during early childhood and, also, an indirect effect through its influence on the family environment.

Follow-up data, obtained 4-7 years after intervention ended, are presented for the Carolina Abecedarian Project, an experimental study of early childhood educational intervention for children from poverty families. Subjects were randomly assigned to 1 of 4 intervention conditions: educational treatment from infancy through 3 years in public school (up to age 8); preschool treatment only (infancy to age 5); primary school treatment only (age 5-8 years), or an untreated control group. Positive effects of preschool treatment on intellectual development and academic achievement were maintained through age 12. School-age treatment alone was less effective. Results generally supported an intensity hypothesis in that scores on cognitive and academic achievement measures increased as duration of treatment increased.

Recently developed methods for power analysis expand the options available for study design. We demonstrate how easily the methods can be applied by (1) reviewing their formulation and (2) describing their application in the preparation of a particular grant proposal. The focus is a complex but ubiquitous setting: repeated measures in a longitudinal study. Describing the development of the research proposal allows demonstrating the steps needed to conduct an effective power analysis. Discussion of the example also highlights issues that typically must be considered in designing a study. First, we discuss the motivation for using detailed power calculations, focusing on multivariate methods in particular. Second, we survey available methods for the general linear multivariate model (GLMM) with Gaussian errors and recommend those based on F approximations. The treatment includes coverage of the multivariate and univariate approaches to repeated measures, MANOVA, ANOVA, multivariate regression, and univariate regression. Third, we describe the design of the power analysis for the example, a longitudinal study of a child's intellectual performance as a function of mother's estimated verbal intelligence. Fourth, we present the results of the power calculations. Fifth, we evaluate the tradeoffs in using reduced designs and tests to simplify power calculations. Finally, we discuss the benefits and costs of power analysis in the practice of statistics. We make three recommendations: Align the design and hypothesis of the power analysis with the planned data analysis, as best as practical.Embed any power analysis in a defensible sensitivity analysis.Have the extent of the power analysis reflect the ethical, scientific, and monetary costs. We conclude that power analysis catalyzes the interaction of statisticians and subject matter specialists. Using the recent advances for power analysis in linear models can further invigorate the interaction.

65 families with children at risk for cognitive difficulties were randomly assigned at the time of the child's birth to 1 of 3 groups, 2 intervention and 1 control. For the most intensive intervention group, family education was combined with a center-based educational day-care program; the less intensive intervention group received the home-based family education program only. To assess the cognitive performance of children, The Bayley Scales of Infant Development were administered at 6, 12, and 18 months; the Stanford-Binet Intelligence Test at 24, 36, and 48 months; and the McCarthy Scales of Children's Abilities at 30, 42, and 54 months. On each test after the 6-month assessment, scores of children in the educational day-care plus family support group were greater than those in the other 2 groups. No cognitive intervention effects were obtained for the family education group. Group effects were not obtained for measures of either the quality of the home environment or parent attention.

We estimated the effects of an experimental educational day care program on the intellectual development of preschoolers from 86 high-risk families in a randomly allocated longitudinal study. At six through 54 months of age, the IQs of experimental program children ranged from 7.9 to 20.1 points higher than those of control children when maternal mental retardation and home environment effects were controlled; at every age, a greater proportion of the experimental program children had normal range IQs (greater than 84). In 13 children with retarded mothers, none of six experimental program children, but six of seven control children, had IQ scores below normal.

Mother-infant dyads (N = 27) were seen as part of a longitudinal study of lower-socioeconomic-status infants at high but varying risk for mild mental retardation. A 20-min unstructured interaction session was videotaped in a laboratory setting when the infants were 6 months old. Transcriptions were made of mothers' speech to their infants. Measures of maternal language included sentence form, amount of speech, and syntactic complexity. It was found that the proportion of imperatives, but not the amount of maternal speech, was positively correlated with a composite measure of risk status (High Risk Index) and negatively correlated with maternal education and WAIS IQ. Similar to previous findings for maternal speech to older infants, syntactic complexity was not significantly related to social risk indices. In terms of descriptive aspects of the data, there was a high degree of variability on the language measures-indicative of wide individual differences in maternal language style.

This report presents continuing longitudinal data of a natural experiment in which fetally malnourished infants and their controls were randomly assigned to 2 environments differing in intellectually supportive characteristics. Whereas a previous report of these infants from 3 to 24 months of age provided evidence supporting the bidirectionality of effects of infant and environmental attributes, this study shows the continuation of the detrimental effects through 36 months of age on intellectual, behavioral, and social-interactional development in a nonsupportive caregiving environment, and the continued amelioration of those effects in a supportive caregiving environment. Further, analyses of maternal variables showed that the mothers of fetally malnourished infants may have had life histories of increased risk when compared to mothers of control infants. The results are discussed in terms of the convergence of dynamic intergenerational, prenatal, and postnatal influences on development.

The social interactions of 60 mother-infant pairs were observed for 25 min in a seminaturalistic setting when the infants were 6 months old and again at 20 months. 46 of the infants were termed at high risk for later school failure due to the socioeconomic situations of their families. Half of these high-risk infants had been randomly assigned to an early intervention program. The remaining group of 14 infants was a sample drawn from the general population. Principal components analyses of the 10 behaviors scored during the session yielded a first component at both 6 and 20 months which represented "dyadic involvement." Comparing the 3 groups of dyads on the proportion within each who scored positively on the dyadic-involvement component, it was evident that the groups did not differ at 6 months but did differ at 20 months. The changes in level of interaction across time were compared with changes in scores on developmental tests. Results indicated that higher dyadic involvement at 20 months was associated with higher intellectual performance.

Longitudinal observations of maternal and infant characteristics were used to investigate the consequences of early day-care intervention for infants at high risk for intellectual retardation due to sociocultural factors. High-risk infants and their mothers were compared on social and intellectual characteristics with a control group not enrolled in an intervention program and with a random sample of mother-child dyads from the general population. Results from group comparisons indicated that mothers of high-risk infants in a day-care intervention group interacted with their infants in ways quite similar to mother of high-risk infants who were not enrolled in the intervention program. Both high-risk groups differed from the general population of mothers on interaction and attitudinal measures. Changes across time on the measures taken were roughly parallel from all three groups. Multiple regression analyses using maternal variables and mother-infant interactional variables to predict 36-month Stanford-Binet scores for the high-risk samples indicated that children's intelligence was predictable from previous maternal behaviors and attitudes, particularly for the control group, and that early day-care intervention apparently had altered the predictiveness of some maternal factors.

The relation of nonoptimal condition at birth to the intellectual development of children reared in 2 different environments was investigated in a 4 1/2-year longitudinal experiment. Subjects were 80 disadvantaged children, half of whom were randomly assigned at birth to a day-care program designed to prevent mild mental retardation and half to an educationally untreated control group. All subjects for this report were full-term and weighed over 2,500 grams at birth; condition at birth was considered nonoptimal if the 1-min Apgar score was less than or equal to 8. Results indicated that nonoptimal perinatal status had significant adverse effects on 4 1/2-year scores on the McCarthy Scales of Children's Abilities in the control group (p less than .01); however, test scores of children with optimal or nonoptimal Apgars did not differ within the group that received educational treatment. The results provide support for a framework stressing initial biological vulnerability and subsequent environmental insufficiency as cumulative risk factors in the development of children from low SES families.

Infants from low socioeconomic status families were randomly assigned to an instructional day-care program designed to prevent socioculturally caused mental retardation or to a nonintervention control group. This assignment procedure resulted in an equal distribution of full-term, full-birth-weight, fetally malnourished babies in 2 environments varying in intellectually supportive characteristics. The condition of fetal malnourishment was defined by infants having low ponderal indices (PI). At 3 months of age low-PI infants showed lower Bayley Mental Development Index (MDI) scores than normal-PI infants, independent of the environment. In the control group low-PI infants still had lower MDI scores than normal-PI infants at 18 months of age. However, at that time in the day-care group, low-PI infants scored as well as normal-PI infants. These findings were replicated when the infants were 24 months of age with Stanford-Binet intelligence tests. Observations of mothers' involvement with their infants showed that, although all groups had similar amounts of maternal involvement when the babies were 6 months of age, the mothers of low-PI infants in the control group showed less involvement with their infants at 18 months of age than the other mothers. We suggest that this longitudinal study provides experimental evidence for a transactional model of development which emphasizes both newborn infant characteristics and environmental quality as cocontributors to the process of development.

Debates regarding the plasticity of intelligence are often fired by a confusion between 2 distinct realms of development, that is, between developmental functions (e.g., a group's average IQ over time) and individual differences (e.g., the relative rank ordering of individual IQs within a group). Questions concerning the stability of these 2 realms are statistically independent. Thus there are 2 kinds of intellectual plasticity, and there may be no developmental convergences between them. In the present study, data from an early intervention program were used to investigate the 2 kinds of plasticity separately and to examine certain possible convergences between them. The program involved children at risk for developmental retardation who were randomly assigned at birth to 2 rearing conditions (i.e., educational daycare vs. no educational intervention) and whose intellectual development was then studied longitudinally to 4 years of age. Our findings indicate that developmental functions are moderately alterable through systemic early education, particularly after infancy, whereas individual differences are moderately stable, again particularly after infancy. They also indicate that the 2 kinds of plasticity are independent; the alteration of developmental functions through daycare affects neither the stability nor the determinants of individual differences. We discuss the implications that these findings have for current models of mental development, for the nature-nurture debate, and for arguments concerning the efficacy of early intervention programs.