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In this review we bring a psychological perspective to the issue of intergenerational economic mobility. More specifically, we present a new dual developmental science framework to consider the educational outcomes of parents and children together in order to foster economic mobility. We focus on two key populations: children in early childhood (from birth to age 6) and parents in early adulthood (in their 20s and early 30s). We posit that mastery of three sets of developmental tasks for each generation—academic/language skills, self-regulation/mental health, and parent-child relationship—will lead to improved educational outcomes for both. Taken as a whole, the dual developmental science framework integrates theory and research on single-generation development (i.e., children or parents) with dynamic and bidirectional theories about the interdependence of children and parents over time.We conclude the review by evaluating existing education interventions and research using the dual developmental science framework, and we discuss opportunities for innovation.

Two-generation human capital programs seek to promote the education of parents and children simultaneously. This study examines relations between family participation in CareerAdvance, which recruits parents of Head Start children into a workforce training program, and children's Head Start attendance. The sample included 293 children (on average 4 years old) and their parents. After one semester, CareerAdvance children demonstrated higher rates of attendance and lower rates of absence and chronic absence (missing 10% or more of school days) than matched comparison children. These associations were similar across a range of high- and low-risk subgroups at baseline. These findings are discussed in terms of the implications of a family systems approach for improving children's Head Start attendance.

Innovation in English as a Second Language (ESL) services to support Latino immigrant parents and their children is needed, and this study examines a novel program that suggests future directions for the field. The Community Action Project of Tulsa County, Oklahoma’s two-generation ESL program recruits parents of children enrolled in Head Start and delivers an ESL curriculum that is contextualized to child development and children’s early school experiences. This mixed methods study explores the progress and the perspectives of parents and staff in this ESL program over two semesters (n = 35). Among enrollees in each semester, parents had high levels of completion (83% in semester 1; 70% in semester 2) and class attendance (94% in semester 1; 88% in semester 2). Yet, only about half (46%) of the parents completed both semesters 1 and 2. Parents who completed either semester 1 or semesters 1 and 2 did exhibit advancement in their English language skills, moving on average from beginner ESL levels to high intermediate levels based on National Reporting System benchmarks. Data from focus groups with parents and staff suggest that involvement in a two-generation ESL program can support parents’ focus on their children, including: (a) alignment of parent curriculum with child development, (b) bidirectional parent and child learning, and (c) an improved sense of parent agency with their children’s schooling and other child-related domains. Implications for future two-generation ESL programming are discussed.

Two-generation human capital programs for families provide education and workforce training for parents simultaneously with education for children. This study uses a quasi-experimental design to examine the effects of a model two-generation program, CareerAdvance, which recruits parents of children enrolled in Head Start into a health care workforce training program. After 1 year, CareerAdvance parents demonstrated higher rates of certification and employment in the health care sector than did matched-comparison parents whose children were also in Head Start. More important, there was no effect on parents' short-term levels of income or employment across all sectors. CareerAdvance parents also experienced psychological benefits, reporting higher levels of self-efficacy and optimism, in addition to stronger career identity compared with the matched-comparison group. Notably, even as CareerAdvance parents juggled the demands of school, family, and employment, they did not report higher levels of material hardship or stress compared with the matched-comparison group. These findings are discussed in terms of the implications of a family perspective for human capital programs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The phenomenon of maternal employment during infancy and its consequences for child development is currently very much in the limelight-in the popular press, public policy debates, and the research arena. Maternal employment during infancy has become a majority phenomenon, topping the SO percent mark only within the last five years. In contrast, the maternal employment literature has only very recently begun to explore the short and long term effects on cognitive outcomes of the timing of mothers' employment in infancy. In terms of long term effects on cognitive development of maternal employment during infancy, there are three studies along these lines, all with different methodologies and contexts. Although the grouping of employed mothers did not distinguish between employment before or after the first year, the majority of employed mothers had been employed in their children's infancy. The maternal employment variables of interest in their study are patterns reflecting the timing and intensity of mothers’ employment.

In 2010, Dr Howard Brody introduced the idea of “the top 5 list” in the New England Journal of Medicine , calling on medical specialties to identify items of overuse to provide high-value care.1 This led to the “choosing wisely” campaign to identify commonly overused measures in medicine in >70 different medical specialties.1 One aspect of this campaign is the “Things We Do For No Reason” articles in the Journal of Hospital Medicine , which focus on the evidence behind common overuse, overdiagnosis, or high-value care issues. These discussions are an important part of pediatric hospital medicine, and efforts to promote this subject must continue. As hospitalists, we also have an obligation to reassess things we should be doing. We will discuss 3 examples briefly in this article but encourage this discussion to continue, at conferences, meetings, and break rooms everywhere. Bronchiolitis is the most common reason infants are hospitalized, and over half require nonoral hydration.2,3 Multiple studies have shown that enteral and nasogastric hydration is comparable to intravenous (IV) hydration in terms of safety and tolerance.2,4,5 A large, randomized controlled trial of infants hospitalized with bronchiolitis did not reveal any significant difference in rates of ICU admission, oxygen therapy duration, ventilator support requirement, or length of stay when comparing IV with nasogastric hydration.2 In a 2018 survey, only 12% of physicians and nurses would choose nasogastric hydration for a healthy infant with bronchiolitis.6 Many practitioners reported concerns about nasal obstruction, parental resistance, and aspiration risk, and 66% did not know that nasogastric hydration was a documented …

OBJECTIVES:To describe interfacility transfers among children with complex chronic conditions (CCCs) and determine if interfacility transfer was associated with health outcomes. We hypothesized that interfacility transfer would be associated with length of stay (LOS), receipt of critical care services, and in-hospital mortality.METHODS:In this retrospective cohort study, we used data from the 2012 Kids’ Inpatient Database. CCC hospitalizations were identified by International Classification of Diseases, Ninth Revision codes. Receipt of critical care services was inferred by using International Classification of Diseases, Ninth Revision diagnosis and procedure codes. We performed a descriptive analysis of CCC hospitalizations then determined if transfer was associated with LOS, mortality, or receipt of critical care services using survey-adapted quasi-Poisson or logistic regression models, controlling for hospital and patient demographics.RESULTS:There were 551 974 non–birth hospitalizations with at least 1 CCC diagnosis code. Of these, 13% involved an interfacility transfer. Compared with patients with CCCs who were not transferred, patients with CCCs who were transferred in and ultimately discharged from the receiving hospital had an adjusted LOS rate ratio of 1.6 (95% confidence interval [CI]: 1.5–1.7; P < .001), were more likely to have received critical care services (adjusted odds ratio 3.0; 95% CI: 2.7–3.2; P < .001), and had higher in-hospital mortality (adjusted odds ratio 3.6; 95% CI: 3.2–3.9; P < .001) (controlling for patient and hospital characteristics).CONCLUSIONS:Many hospitalizations for children with CCCs involve interfacility transfer. Compared with in-house admissions, hospitalizations of patients who are transferred in and ultimately discharged from the receiving hospital involve longer LOS, greater odds of receipt of critical care services, and in-hospital mortality. Further evaluation of the role of clinical and transfer logistic factors is needed to improve outcomes.

Improving children's attendance is a high priority for Head Start and other early childhood education programs serving low-income children. We conducted a randomized control trial in a major northern city to evaluate the impact of a low-cost intervention designed to promote parents' social capital as a potential influence on children's attendance in Head Start centers. The intervention assigned children to treatment group classrooms based on (a) neighborhood of residence (geography condition) or (b) the geography condition plus the opportunity for parents to form partnerships in support of their children's attendance, or to control group classrooms according to Head Start guidelines only. We did not find impacts on average attendance throughout the year. However, the intervention did lead to increased attendance during the winter when average center attendance was lowest. There were no impacts on fall or spring attendance. Follow-up exploratory analyses of focus groups with parents and staff sugge...

Two-generation programs provide education and training services for parents while their children attend early childhood education programs. This study examines the rates of persistence and certification of parents in one of the only two-generation interventions in the country under study, Career Advance ®, which offers training in the healthcare sector to parents while their children attend Head Start ( n = 92). Results indicate that 16 months after enrolling in Career Advance ®, 76% of participants attained at least one workforce-applicable certificate of the program and 59% were still in the program. The majority of parents who left the program during the 16 months had attained a certificate (68%). Parents with high levels of material hardship were more likely to attain a certificate and stay enrolled in the program, and parents with higher levels of psychological distress were less likely to attain a certificate in the same time period. Implications for future two-generation programming are discussed.

This paper examines the extent to which a new nationally representative household panel survey could bring children and adolescents to the forefront of its design. We begin by discussing how major demographic shifts, such as reduced social mobility and transformations in family structure, may affect children and adolescent development through individual, family, and sociocultural processes. We then review the existing household surveys in the United States and highlight the strengths and weaknesses for studying how major societal trends and changes affect child and adolescent development. We then debate several different design approaches for a new study and recommend either a longitudinal panel design, which includes all children in the panel survey, or a sequential cohort design, that includes a subsample of children and embedded birth cohort study. We highlight that a large, nationally representative dataset cannot replace standalone, more in-depth developmental studies of children and adolescents with high-fidelity measurement of processes. Instead, we argue that a new panel survey could take a more targeted approach and measure the major constructs of children's development as well as select family and sociocultural processes by drawing on recent advances in survey measurement techniques. We conclude by affirming that new household survey has the potential to contribute greatly to our understanding of the developmental origins of life long wellbeing as well as the effects of major demographic shifts in the 21st century on child and adolescent development.

A 2-year-old female presents for evaluation of 4 weeks of daily fevers. When the fevers began, she had mild upper respiratory tract symptoms, which quickly resolved. The fevers persisted, however, with a maximum of 40°C. The child’s review of symptoms was significant for a 1-kg weight loss over the past month. Ten months before presentation, she had moved from Saudi Arabia with her family. One week before the onset of symptoms, she had visited a petting zoo. During episodes of fever, the patient was ill-appearing and had an elevated heart rate and respiratory rate. On examination, she was found to be thin, febrile, tachycardic, and with scattered lymphadenopathy. Results of laboratory tests were remarkable for an elevated white blood cell count of 16 100 cells per uL with a neutrophilic predominance. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were elevated at 99 mm/h and 27 mg/dL, respectively. A chest radiograph indicated a small amount of fluid in the interlobar fissures. Our expert panel examines her case, offers a definition of fever of unknown origin, and makes diagnostic considerations.

Background Although often short-lived and self-limiting, postoperative atrial fibrillation (POAF) is a well-recognized postoperative complication of cardiac surgery and is associated with a 2-fold increase in cardiovascular mortality and morbidity. Objective Our aim was to determine whether intraoperative bilateral pulmonary vein radiofrequency ablation decreases the incidence of POAF in patients undergoing coronary artery bypass grafting (CABG). Methods A total of 175 patients undergoing CABG was prospectively randomized to undergo adjuvant bilateral radiofrequency pulmonary vein ablation in addition to CABG (group A; n=89) or CABG alone (group B; n=86). Intraoperative pulmonary vein isolation was confirmed by the inability to pace the heart via the pulmonary veins after ablation. All patients received postoperative β-blocker. Results There was no difference in the incidence of POAF in the treatment group who underwent adjuvant pulmonary vein ablation (group A; 37.1%) compared with the control group who did not (group B; 36.1%) ( P = .887). There were no differences in postoperative inotropic support, antiarrhythmic drug use, need for oral anticoagulation, and complication rates. The mean length of postoperative hospital stay was 8.2 ± 6.5 days in the ablation group and 6.7 ± 4.6 days in the control group ( P Conclusion Adjuvant pulmonary vein isolation does not decrease the incidence of POAF or its clinical impact but increases the mean length of stay in the hospital. The mechanism of POAF does not appear to depend on the pulmonary veins.

Head Start is the oldest and largest federally funded preschool program in the United States. From its inception in 1965, Head Start not only provided early childhood education, care, and services for children, but also sought to promote parents’ success. However, almost all evaluation studies of Head Start have focused solely on children's cognitive and social outcomes rather than on parents’ outcomes. The present study examines whether children's participation in Head Start promotes parents’ educational advancement and employment. We use data from the Head Start Impact Study (HSIS), a randomized trial of over 4,000 newly entering three- and four-year-old children. We find that parents of children in the three-year-old cohort (but not the four-year-old cohort), who were randomly assigned to and participated in Head Start, had steeper increases in their own educational attainment by child age six years compared to parents of children in the control group. This pattern is especially strong for parents who had at least some college experience at baseline, as well as for African-American parents. We do not find evidence that Head Start helped parents enter or return to the workforce over time. Results are discussed in the context of using high-quality early childhood education as a platform for improving both child and parent outcomes.

OBJECTIVE: To improve the frequency of electronic prescribing (e-prescribing) of discharge prescriptions at a children’s hospital via a bundle of quality improvement interventions. METHODS: Surveys and focus groups were conducted with patient families and pediatric residents to identify barriers and propose solutions to e-prescribing. These data were used to generate a series of interventions, including the following: (1) provider education; (2) changes in patient registration workflow; and (3) electronic health record changes to improve the frequency of e-prescribing on the pediatric hospital medicine (PHM) service. The primary outcome measure was the e-prescribing frequency, with a balance measure of e-prescribing errors. RESULTS: From July 2014 through June 2015, e-prescribing frequency on the PHM service improved from a median of 7.4% to 48.9% (P < .001) and was sustained for an additional 6 months (July 2015–December 2015), surpassing meaningful use targets with associated US News and World Report hospital ranking points. The frequency of PHM prescription errors remained unchanged, and in comparison, the resident outpatient clinic revealed no statistically significant change in e-prescribing frequency during this time period. CONCLUSIONS: Engaging front-line providers in hospital-wide initiatives and quality improvement interventions can directly affect hospital metrics in programs such as meaningful use and US News and World Report, as shown through successful improvement in PHM e-prescribing frequency. Future studies are necessary to determine whether increased e-prescribing frequency affects patient outcomes and compliance.

OBJECTIVES: Breastfeeding rates differ among racial/ethnic groups in the United States. Our aim was to test whether racial/ethnic disparities in demographic characteristics, hospital use of infant formula, and family history of breastfeeding mediated racial/ethnic gaps in breastfeeding outcomes. METHODS: We analyzed data from the Community and Child Health Network study (N = 1636). Breastfeeding initiation, postnatal intent to breastfeed, and breastfeeding duration were assessed postpartum. Hierarchical linear modeling was used to estimate relative odds of breastfeeding initiation, postnatal intent, and duration among racial/ethnic groups and to test the candidate mediators of maternal age, income, household composition, employment, marital status, postpartum depression, preterm birth, smoking, belief that “breast is best,” family history of breastfeeding, in-hospital formula introduction, and WIC participation. RESULTS: Spanish-speaking Hispanic mothers were most likely to initiate (91%), intend (92%), and maintain (mean duration, 17.1 weeks) breastfeeding, followed by English-speaking Hispanic mothers (initiation 90%, intent 88%; mean duration, 10.4 weeks) and white mothers (initiation 78%, intent 77%; mean duration, 16.5 weeks); black mothers were least likely to initiate (61%), intend (57%), and maintain breastfeeding (mean duration, 6.4 weeks). Demographic variables fully mediated disparities between black and white mothers in intent and initiation, whereas demographic characteristics and in-hospital formula feeding fully mediated breastfeeding duration. Family breastfeeding history and demographic characteristics helped explain the higher breastfeeding rates of Hispanic mothers relative to white and black mothers. CONCLUSIONS: Hospitals and policy makers should limit in-hospital formula feeding and consider family history of breastfeeding and demographic characteristics to reduce racial/ethnic breastfeeding disparities.

Background/ContextEconomic, developmental, and sociological theories and research suggest that there are benefits associated with on-time postsecondary credentialing and training for low-income parents even though this often means the management of family, work, and school while children are young. This argument is based on three conclusions drawn from the literature: (1) early childhood is a time when children are uniquely responsive to their environments, and interventions during this developmental period result in greater returns on investments than do later interventions; (2) maternal postsecondary credentials may be more beneficial for younger children than for older school-aged children; and (3) the educational advancements of parents strengthen the economic and social assets of families and are likely to help break the intergenerational cycle of poverty.Purpose/Objective/Research Question/Focus of StudyThis study places special emphasis on exploring how an early childhood education center can enhance the educational prospects of parents of young children and poses the following three questions: (1) How do young low-income mothers vary in their readiness for postsecondary success? (2) How does participation in high-quality early childhood education programs support mothers’ educational pursuits? (3) How do mothers, in the context of high-quality early education, connect their educational goals for their children with their own educational goals?Research DesignIn-depth qualitative interviews were conducted with 12 intentionally and 39 randomly selected parents whose children were enrolled in urban early childhood centers in Denver, Colorado; Chicago, Illinois; and Miami, Florida. Seventeen focus groups were carried out with program staff and teachers at the three centers. All transcribed interview data were analyzed through the creation of individual profiles to examine variation in mothers’ postsecondary readiness and through a “grounded theory” approach.Findings/ResultsResults indicate that (a) low-income mothers vary in their potential for postsecondary success and can be classified in three clusters; (b) all mothers are concerned for their children's education, and most believe that a college education is economically essential; (c) participation in high-quality early education may make a difference in mothers’ views of their potential; and (d) those who observe their children thriving in an early childhood program may be more motivated to pursue their own education.Conclusions/RecommendationsTogether, these results suggest a new framework for addressing the postsecondary and career needs of low-income families with young children: High-quality early childhood education centers may be a promising platform for adult education and training. Gains in educational attainment made through participation in such programming may cultivate skills and knowledge among parents that will not only improve their financial stability but also promote the educational and social development of their children. References

The relationship between Latino fathers’ immigrant status and their involvement with their 12-month-old infants was examined using the Fragile Families data set, a longitudinal birth cohort study. We examined differences among 787 immigrant and nonimmigrant Latino fathers along three dimensions of father involvement— accessibility, engagement, and caretaking, as reported by both mothers and fathers. First generation immigrant fathers were more accessible to their infants, but showed lower levels of engagement with and caretaking of their children compared to nonimmigrant fathers, controlling for numerous background factors. Immigrant fathers’ lower level of engagement was partially mediated by fathers’ traditional attitudes. Findings indicate that there may be some culturally different norms for immigrant fathering. Culturally-relevant measures of fathering should be included in future large-scale studies, including constructs such as familism and acculturation.

Research examining the longer term influences of child care on children’s development has expanded in recent years, but few studies have considered low-income children’s experiences in community care arrangements. Using data from the Three-City Study (N = 349), the present investigation examines the influences of child care quality, extent and type on low-income children’s development of behavior problems during middle childhood (7–11 years old). Higher levels of child care quality were linked to moderate reductions in externalizing behavior problems. High-quality child care was especially protective against the development of behavior problems for boys and African American children. Child care type and the extent of care that children experienced were generally unrelated to behavior problems in middle childhood.

The present study investigated the association of mothers’ marriage and changes in young adolescents’ cognitive and socioemotional development and changes in family processes. Analyses employed longitudinal data from the Three-City Study to track maternal partnerships for 860 lowincome adolescents (10–14 years-old in Wave 1) across a 16 month period. No short-term benefits or risks emerged for youth when mothers entered marriage, with few changes in family or maternal functioning linked with marriage formation as well. In contrast, adolescents in stably married families experienced improved academic, behavioral, and psychological well-being compared to youth in stable cohabiting or single-parent families. Stable marriage was similarly linked to improvements across multiple domains of home and mothers’ functioning. These patterns were not moderated by the male partner’s identity (biological father or stepfather). Results support the benefits of stable marriage on youth development, but suggest that policies supporting movements into new marriages may not result in improved adolescent or family functioning, at least in the short term.

This article examines whether longitudinal reading trajectories vary by the generational status of immigrant children as they begin formal schooling through the 3rd grade. The results of the hierarchical linear model indicated that 1st and 2nd generation children (i.e., those born in a foreign country and those born in the United States to foreign-born parents, respectively) had higher achievement scores at the spring of kindergarten than did 3rd generation children. Yet, controlling for race/ethnicity and maternal education fully reduced the 1st generation advantage. In addition, 1st generation children grew in reading achievement at a faster rate than did 3rd generation children. Controlling for a host of proximal and distal factors that included demographic, race/ethnic, family, and school characteristics somewhat reduced the association between generational status and rate of growth. First and 2nd generation children continued to increase their reading scores at a faster rate than did 3rd generation children. It is likely that additional factors not measured in the Early Childhood Longitudinal Survey-Kindergarten cohort, such as selection, cultural, or motivational factors, would be useful in further explaining the immigrant advantage.

Numerous studies have assessed families' employment and financial stability following welfare reform. Yet little research has addressed whether welfare and work transitions are linked with other changes in family functioning. Using a representative sample of approximately 2,000 low-income urban families from the Three-City Study, analyses assessed whether mothers' welfare and employment experiences over a two-year period following welfare reform were related to changes in family well-being. Lagged regression models controlling for family characteristics and earlier levels of functioning found that moving into employment and stable employment (of 30 hours or more per week) were linked to substantial increases in income and improvements in mothers' psychological well-being. Movements into employment also were associated with declines in financial strain and food insecurity. Sustained or initiated welfare receipt was related to relative declines in income, physical health, and psychological well-being, but also to improved access to medical care. In contrast, mothers' welfare and work experiences showed very limited relations to changes in the quality of parenting or of children's home environments. These patterns were similar for families with young children and those with adolescent children. Results suggest that parenting behaviors are more resistant to change than are maternal emotional and economic functioning.

We introduce this special issue on the critical matter of whether the existing household panel surveys in the U.S. are adequate to address the important emerging social science and policy questions of the next few decades. We summarize the conference papers which address this issue in different domains. The papers detail many new and important emerging research questions but also identify key limitations in existing panels in addressing those questions. To address these limitations, we consider the advantages and disadvantages of initiating a new, general-purpose omnibus household panel in the U.S. We also discuss the particular benefits of starting new panels that have specific targeted domains such as child development, population health and health care. We also develop a list of valuable enhancements to existing panels which could address many of their limitations.

Despite a growing understanding that the social determinants of health have an impact on body mass index (BMI), the role of fatherhood on young men’s BMI is understudied. This longitudinal study examines BMI in young men over time as they transition from adolescence into fatherhood in a nationally representative sample. Data from all four waves of the National Longitudinal Study of Adolescent Health supported a 20-year longitudinal analysis of 10,253 men beginning in 1994. A “fatherhood-year” data set was created and changes in BMI were examined based on fatherhood status (nonfather, nonresident father, resident father), fatherhood years, and covariates. Though age is positively associated with BMI over all years for all men, comparing nonresident and resident fathers with nonfathers reveals different trajectories based on fatherhood status. Entrance into fatherhood is associated with an increase in BMI trajectory for both nonresident and resident fathers, while nonfathers exhibit a decrease over the same period. In this longitudinal, population-based study, fatherhood and residence status play a role in men’s BMI. Designing obesity prevention interventions for young men that begin in adolescence and carry through young adulthood should target the distinctive needs of these populations, potentially improving their health outcomes.

Individuals with a bicuspid aortic valve (BAV) are at increased risk for ascending aortic dilation and dissection. Loss of aortic medial smooth muscle cells (SMCs) and disruption of the extracellular matrix are well-recognized pathologies, but the underlying cellular mechanisms remain elusive. We tested the hypothesis that the dilated aorta in patients with BAV was marked by accelerated cellular aging. Samples of human ascending aorta were obtained from individuals with BAV undergoing thoracic aorta replacement (n=37, age 54.7±2.2, aortic diameter 4.8±0.9 cm) or patients with a tricuspid aortic valve and non-dilated aorta undergoing heart transplantation or coronary bypass procedures (n=6, age 55.3±8.1, aortic diameter 3.1±0.3 cm). Assessment of fresh aortic samples for senescence-associated β-galactosidase revealed evidence for rare medial cell senescence that was 4.2-fold more prevalent in dilated aortas (0.83±0.10%) than in non-dilated aortas (0.20±0.10%, p=0.048). Expression of p16 was abundantly detected in medial SMCs within dilated aortas (27.0±2.1%) and 3-fold more abundant than in non-dilated aortas (8.9±1.8%, p

The current investigation examined whether two dimensions of children's temperament—effortful control and negative emotionality—moderated links between mothers' welfare and work transitions and preschoolers' developmental trajectories (N = 445). Data were drawn from a sample of low-income, predominantly ethnic minority children and their mothers, when children were ages 2–4, and again 16 months later. Among children whose mothers' left welfare or entered work, high effortful control and low negative emotionality were not protective factors in children's socioemotional or cognitive functioning. However, when mothers experienced job loss or entered the welfare system, preschoolers with high effortful control displayed better developmental outcomes over time than children with low effortful control.

Twenty years ago, the National Institute of Child Health and Human Development (NICHD) issued a request for proposals that resulted in the National Survey of Families and Households (NSFH), a unique survey valuable to a wide range of family scholars. This paper describes the efforts of an interdisciplinary group of family demographers to build on the progress enabled by the NSFH and many other theoretical and methodological innovations. Our work, also supported by NICHD, will develop plans for research and data collection to address the central question of what causes family change and variation. We outline the group's initial assessments of orienting frameworks, key aspects of family life to study, and theoretical and methodological challenges for research on family change. Finally, we invite family scholars to follow our progress and to help develop this shared public good.

To examine the implications of custodial grandparent care, we compared the material hardship, mental health, and physical well-being of custodial grandmothers (n = 90) and biological mothers (n = 1,462) using data from Welfare, Children, and Families: A Three-City Study. Custodial grandmothers reported significantly more physical health problems but less psychological distress than mothers. Younger grandmothers and grandmothers who sought out more social support were the most disabled and financially strained. Implications for policy and practice addressing the needs of grandmothers raising grandchildren are discussed. Key Words: caregiving, economic distress, grandmothers raising grandchildren, health, low-income families. Over the past few decades, American families have increasingly relied on grandparents to assume caregiving responsibility for their grandchildren (Bryson & Casper, 1999). In the 2000 Census, 2.4 million "grandparent caregivers" for grandchildren younger than 18 years of age were identified, and approximately two thirds of these caregivers were women (Simmons & Dye, 2003). These caregiving arrangements are especially prevalent in low-income communities as growing numbers of kin offer a safety net for families in crisis (Kornhaber, 1985). Yet, perceptions about grandmothers' caregiving status have differed in research and policy arenas. For example, past research has generally compared custodial grandmothers to other types of grandmothers, such as coresiding or noncaregiving grandmothers (e.g., Caputo, 1999; Pebley & Rudkin, 1999; Szinovacz, 1998). In contrast, social welfare systems often treat custodial grandmothers as primary caregivers or "mothers." For example, just six states administer formal exemptions from work requirements or time limits to custodial grandmothers under the age of 60 if their families are receiving Temporary Assistance for Needy Families (TANF) aid (Hutson, 2002). In the present study, we adopt a policy perspective and view custodial grandmothers as a type of primary caregiver or mother, rather than a type of grandmother. This distinction highlights the variation in low-income families with children and emphasizes the unique needs and circumstances facing different groups of primary caregivers so that practitioners and policymakers will be better informed. Thus, we endeavored to (a) compare the material hardship, mental health, and physical well-being of custodial grandmothers and mothers from low-income neighborhoods; (b) determine whether differences in demographic characteristics, caregiving burden, or social support sources account for any discrepancies in caregivers' hardship and health; and (c) examine whether subgroups of custodial grandmothers are particularly at risk for adverse outcomes. Background and Significance Almost 15% of American grandmothers have raised one or more grandchildren for at least 6 months (Szinovacz, 1998). National household surveys have shown that higher proportions of custodial grandparent care are evident among families living below the poverty line and among African American families (Caputo, 2001). These care arrangements frequently involve multiple grandchildren (Caputo, 1999; Szinovacz) and last longer than 6 months (Fuller-Thomson, Minkler, & Driver, 1997). Custodial grandmothers are more likely to be single, have lower levels of education, and are significantly younger than noncaregiving or coresidential grandmothers (Pebley & Rudkin, 1999; Pruchno & McKenney, 2000). Custodial grandmother kinship care arrangements tend to form in response to urgent needs or problems facing parents and in more extreme cases, parental absence or incapacitation, stemming from substance abuse, AIDS, incarceration, abandonment, or death (Burnette, 1999; Whitley, Kelley, & Sipe, 2001). Grandparents may also serve as formal or informal guardians when children have been removed from their homes by child protective services because of parental abuse or neglect (Jendrek, 1994; Whitley et al. …

Using a representative sample of low‐income, urban preschoolers (n = 755) and adolescents (n = 1,130), this article addresses links among family welfare receipt, family processes, and child outcomes. For adolescents, family welfare receipt is related to decreased cognitive achievement and heightened behavioral and emotional problems. For preschoolers, both current and past welfare receipt are associated with problematic functioning. Families who received welfare sanctions have children with particularly problematic developmental outcomes. Mothers’ human capital, health, and parenting practices attenuate many of these links. Policy implications regarding potential impacts of welfare reform on children’s developmental trajectories are discussed.

Associations between histories of family disruption (residential moves and separations from parent figures) and adolescent adjustment (including educational, internalizing, externalizing, and sexual behavior outcomes) were examined in a random sample of 267 African American girls from 3 urban poverty neighborhoods. Higher numbers of residential moves and parental separations significantly predicted greater adolescent adjustment problems after household demographic characteristics were controlled. Adolescents' perceptions of their current relationships and neighborhoods were significantly associated with adolescent adjustment but did not mediate the effects of family disruption. Associations between parental separations and adolescent outcomes were strongest for externalizing problems and were found for both male and female caregivers, for long-standing and more temporary caregivers, and for separations in early childhood, middle childhood, and adolescence.

Most of the authors in this issue of Future of Children focus on a single strategy for helping both adults and children that could become a component of two-generation programs. Lindsay Chase-Lansdale and Jeanne Brooks-Gunn, on the other hand, look at actual programs with an explicit two-generation focus that have been tried in the past or are currently under way. These explicitly two-generation programs have sought to build human capital across generations by combining education or job training for adults with early childhood education for their children. Chase-Lansdale and Brooks-Gunn explain the theories behind these programs and review the evidence for their efficacy. A first wave of such programs in the 1980s and 1990s produced mostly disappointing results, but the evaluations they left behind pointed to promising new directions. More recently, a second wave of two-generation programs--the authors dub them "Two-Generation 2.0"--has sought to rectify the flaws of earlier efforts, largely by building strong connections between components for children and adults, by ensuring that children and adults receive services of equal duration and intensity, and by incorporating advances in both education and workforce development. These Two-Generation 2.0 programs are still in their infancy, and we have yet to see clear evidence that they can achieve their goals or be implemented cost-effectively at scale. Nonetheless, Chase-Lansdale and Brooks-Gunn write, the theoretical justification for these programs is strong, their early results are promising, and the time is ripe for innovation, experimentation, and further study.

BACKGROUND AND OBJECTIVE: Rates of paternal depression range from 5% to 10% with a growing body of literature describing the harm to fathers, children, and families. Changes in depression symptoms over the life course, and the role of social factors, are not well known. This study examines associations with changes in depression symptoms during the transition to fatherhood for young fathers and whether this association differed by key social factors. METHODS: We combined all 4 waves of the National Longitudinal Study of Adolescent Health to support a 23-year longitudinal analysis of 10 623 men and then created a “fatherhood-year” data set, regressing age-adjusted standardized depressive symptoms scores on fatherhood status (nonresidence/residence), fatherhood-years, and covariates to determine associations between Center for Epidemiologic Studies Depression Scale scores and fatherhood life course intervals. RESULTS: Depressive symptom scores reported at the entry into fatherhood are higher for nonresident fathers than nonfathers, which in turn are higher than those of resident fathers. Resident fathers have a significant decrease in scores during late adolescence (β = –0.035, P = .023), but a significant increase in scores during early fatherhood (β = 0.023, P = .041). From entrance into fatherhood to the end of early fatherhood (+5 years), the depressive symptoms score for resident fathers increases on average by 68%. CONCLUSIONS: In our longitudinal, population-based study, resident fathers show increasing depressive symptom scores during children's key attachment years of 0–5. Identifying at-risk fathers based on social factors and designing effective interventions may ultimately improve health outcomes for the entire family.

Recently, there have been several retrospective reports suggesting an increased frequency in seizures after cardiopulmonary bypass, associated with increased patient morbidity. We sought to prospectively investigate the incidence of electrographic seizures without clear convulsive clinical correlates and subsequent neurologic injury following cardiac surgery. This single-center, prospective, observational study used continuous subhairline electroencephalographic (cEEG) monitoring in the intensive care unit following routine cardiac surgery, ranging from coronary bypass surgery to complex aortic arch reconstruction. The primary outcome was the proportion of patients developing postoperative seizures, as confirmed on cEEG monitoring. Secondary outcomes included neurologic injury, post-operative complications, mortality, and ICU and hospital lengths of stay. 101 consenting patients were included and 3 patients had seizures (2 focal and convulsive, 1 generalized and electrographic). All three patients with seizures were ≥65 years old, had “open-chamber” procedures, and had cardiopulmonary bypass times >120 min. One of the 3 patients with seizures was exposed to higher doses of tranexamic acid. None of the patients with seizures had permanent neurologic sequelae and all were doing well at 1-year follow-up. There was no increased morbidity or mortality in patients with seizures. Electrographic seizures occur infrequently after cardiac surgery and are generally associated with a good prognosis. Prophylactic cEEG monitoring is unlikely to be cost-effective in this population. (ClinicalTrials.gov Identifier: NCT01291992).

Data are used from a random sample of African American families in impoverished Chicago neighborhoods to address two questions: How well do modeling, supervision, and marital transition hypotheses explain the relationship between family structure and early sexual debut and pregnancy for disadvantaged Black female adolescents? Do higher levels of social support from parents and neighborhood adults decrease the risk of sexual activity for youth in poor communities? Support for each hypothesis is contingent upon the family transition experienced and specific sexual outcome examined. Living in any type of married household reduces the risk of sexual debut and pregnancy. Stronger parent-child relationships are associated with delayed sexual onset, whereas the risk of pregnancy is reduced when adolescents report more working adults in their social networks.

The relationship between parenting style and adolescent functioning was examined in a sample of 302 African American adolescent girls and their mothers who lived in impoverished neighborhoods. Although previous research has found that authoritative parenting, as compared with authoritarian, permissive, and disengaged parenting, is associated with positive adolescent outcomes in both European American, middle-class and large multiethnic school-based samples, these parenting categories have not been fully explored in African American families living at or near poverty level. Data were collected from adolescent girls and their self-identified mothers or mother figures using in-home interviews and self-administered questionnaires. Parenting style was found to be significantly related to adolescent outcome in multiple domains including externalizing and internalizing behaviors, academic achievement, work orientation, sexual experience, and pregnancy history. Specifically, teens whose mothers were disengaged (low on both parental warmth and supervision/monitoring) were found to have the most negative outcomes.