Publications by authors named "Joshua Jeong"

20 Publications

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Exposure to violence, polyvictimization and youth's mental health and alcohol use in El Salvador.

Child Abuse Negl 2021 Jun 16;118:105158. Epub 2021 Jun 16.

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Electronic address:

Background: Community and family violence are major global health problems. Approximately 1.3 million deaths around the world and 2.5% of global mortality are due to violence. In El Salvador, youth are exposed to multiple levels of physical and emotional violence, abuse, and crime.

Objective: The objective of this study was to investigate the various sources of violence against youth and determine the associations with mental distress symptoms, suicidal ideation, and alcohol use outcomes.

Participants And Setting: We use information gathered in 2017 from a representative sample of 13- to 24-year-old adolescents and young adults from El Salvador.

Methods: Data used in this analysis came from a nationally cross-sectional household survey called Violence Against Children Survey (VACS) in El Salvador. We used logistic regression models to determine the associations between lifetime witnessing violence, exposure to physical, sexual, emotional violence, and youth mental health outcomes.

Results: Polyvictimization was associated with greater odds of each mental health outcome after adjusting for confounders. The strongest relative association was observed between emotional violence and mental distress. Sexual violence and emotional violence were predictors of suicidal ideation. Finally, physical violence and sexual violence were associated with alcohol use. The greatest associations were observed between sexual violence perpetrated by a parent, peer, or another adult in the community and suicidal ideation, at a magnitude of approximately six times higher odds.

Conclusions: Preventing violence against youth is likely to improve mental health and wellbeing in El Salvador and other similar contexts worldwide.
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http://dx.doi.org/10.1016/j.chiabu.2021.105158DOI Listing
June 2021

Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis.

PLoS Med 2021 May 10;18(5):e1003602. Epub 2021 May 10.

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.

Background: Parents are the primary caregivers of young children. Responsive parent-child relationships and parental support for learning during the earliest years of life are crucial for promoting early child development (ECD). We conducted a global systematic review and meta-analysis to evaluate the effectiveness of parenting interventions on ECD and parenting outcomes.

Methods And Findings: We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Global Health Library for peer-reviewed, published articles from database inception until November 15, 2020. We included randomized controlled trials (RCTs) of parenting interventions delivered during the first 3 years of life that evaluated at least 1 ECD outcome. At least 2 reviewers independently screened, extracted data, and assessed study quality from eligible studies. ECD outcomes included cognitive, language, motor, and socioemotional development, behavior problems, and attachment. Parenting outcomes included parenting knowledge, parenting practices, parent-child interactions, and parental depressive symptoms. We calculated intervention effect sizes as the standardized mean difference (SMD) and estimated pooled effect sizes for each outcome separately using robust variance estimation meta-analytic approaches. We used random-effects meta-regression models to assess potential effect modification by country-income level, child age, intervention content, duration, delivery, setting, and study quality. This review was registered with PROSPERO (CRD42018092458 and CRD42018092461). Of the 11,920 articles identified, we included 111 articles representing 102 unique RCTs. Pooled effect sizes indicated positive benefits of parenting interventions on child cognitive development (SMD = 0.32, 95% CI [confidence interval]: 0.23, 0.40, P < 0.001), language development (SMD = 0.28, 95% CI: 0.18 to 0.37, P < 0.001), motor development (SMD = 0.24, 95% CI: 0.15 to 0.32, P < 0.001), socioemotional development (SMD = 0.19, 95% CI: 0.10 to 0.28, P < 0.001), and attachment (SMD = 0.29, 95% CI: 0.18 to 0.40, P < 0.001) and reductions in behavior problems (SMD = -0.13, 95% CI: -0.18 to -0.08, P < 0.001). Positive benefits were also found on parenting knowledge (SMD = 0.56, 95% CI: 0.33 to 0.79, P < 0.001), parenting practices (SMD = 0.33, 95% CI: 0.22 to 0.44, P < 0.001), and parent-child interactions (SMD = 0.39, 95% CI: 0.24 to 0.53, P < 0.001). However, there was no significant reduction in parental depressive symptoms (SMD = -0.07, 95% CI: -0.16 to 0.02, P = 0.08). Subgroup analyses revealed significantly greater effects on child cognitive, language, and motor development, and parenting practices in low- and middle-income countries compared to high-income countries; and significantly greater effects on child cognitive development, parenting knowledge, parenting practices, and parent-child interactions for programs that focused on responsive caregiving compared to those that did not. On the other hand, there was no clear evidence of effect modification by child age, intervention duration, delivery, setting, or study risk of bias. Study limitations include considerable unexplained heterogeneity, inadequate reporting of intervention content and implementation, and varying quality of evidence in terms of the conduct of trials and robustness of outcome measures used across studies.

Conclusions: Parenting interventions for children during the first 3 years of life are effective for improving ECD outcomes and enhancing parenting outcomes across low-, middle-, and high-income countries. Increasing implementation of effective and high-quality parenting interventions is needed globally and at scale in order to support parents and enable young children to achieve their full developmental potential.
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http://dx.doi.org/10.1371/journal.pmed.1003602DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8109838PMC
May 2021

From fathers to peers: Association between paternal violence victimization and peer violence perpetration among youth in Malawi, Nigeria, and Zambia.

Soc Sci Med 2021 06 17;278:113943. Epub 2021 Apr 17.

Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA. Electronic address:

Interpersonal violence against children and youth, including parental violence and peer violence, are major global health concerns. However, the majority of the parental violence and peer violence literature examines each separately from one another. In this study, we specifically investigate the role of fathers and whether paternal violence victimization is associated with peer violence perpetration, above and beyond maternal violence victimization. We used nationally-representative data from three sub-Saharan African country surveys of the Violence Against Children Surveys, which comprised a pooled sample of 8184 youth aged 13-24 years in Malawi (conducted in 2013), Nigeria (2014), and Zambia (2014). We used multivariable logistic regression models to estimate the association between paternal violence victimization and peer violence perpetration, controlling for maternal violence victimization, witnessing violence, and other covariates. We also tested a structural equation model to determine whether the direct association between paternal violence victimization and peer violence perpetration was mediated through youth mental distress or alcohol use, controlling for other violence exposures and covariates. In the pooled sample, 22.8% of youth reported paternal violence victimization, and 18.8% of youth reported peer violence perpetration in their lifetime. Youth who experienced paternal violence had a greater odds of perpetrating peer violence (OR = 1.74, 95% CI: 1.50-2.02), compared with youth who did not experience paternal violence and after controlling for maternal violence victimization and other covariates. Structural equation model results revealed that approximately a quarter of the total association between paternal violence victimization and peer violence perpetration was mediated by youth mental distress and alcohol use. Our study underscores the role of fathers in the context of parental violence against youth and highlights the need for multicomponent and two-generation violence prevention interventions that address paternal violence and support youth psychosocial wellbeing to prevent cycles of violence perpetration against youth in sub-Saharan Africa.
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http://dx.doi.org/10.1016/j.socscimed.2021.113943DOI Listing
June 2021

Redesigning and delivering inclusive parenting interventions for fathers.

Authors:
Joshua Jeong

Lancet Glob Health 2021 05;9(5):e596

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston 02115, MA, USA. Electronic address:

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http://dx.doi.org/10.1016/S2214-109X(21)00037-1DOI Listing
May 2021

Leaf-inspired homeostatic cellulose biosensors.

Sci Adv 2021 Apr 16;7(16). Epub 2021 Apr 16.

Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea.

An incompatibility between skin homeostasis and existing biosensor interfaces inhibits long-term electrophysiological signal measurement. Inspired by the leaf homeostasis system, we developed the first homeostatic cellulose biosensor with functions of protection, sensation, self-regulation, and biosafety. Moreover, we find that a mesoporous cellulose membrane transforms into homeostatic material with properties that include high ion conductivity, excellent flexibility and stability, appropriate adhesion force, and self-healing effects when swollen in a saline solution. The proposed biosensor is found to maintain a stable skin-sensor interface through homeostasis even when challenged by various stresses, such as a dynamic environment, severe detachment, dense hair, sweat, and long-term measurement. Last, we demonstrate the high usability of our homeostatic biosensor for continuous and stable measurement of electrophysiological signals and give a showcase application in the field of brain-computer interfacing where the biosensors and machine learning together help to control real-time applications beyond the laboratory at unprecedented versatility.
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http://dx.doi.org/10.1126/sciadv.abe7432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051876PMC
April 2021

Short-term, medium-term and long-term effects of early parenting interventions in low- and middle-income countries: a systematic review.

BMJ Glob Health 2021 03;6(3)

Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Basel-Stadt, Switzerland.

Introduction: Parenting interventions during early childhood are known to improve various child development outcomes immediately following programme implementation. However, less is known about whether these initial benefits are sustained over time.

Methods: We conducted a systematic literature review of parenting interventions in low- and middle-income countries (LMICs) that were delivered during the first 3 years of life and had completed a follow-up evaluation of the intervention cohort at least 1 year after the primary postintervention endpoint. We summarized intervention effects over time by child-level and parent-level outcomes as well as by timing of follow-up rounds in the short-term (1-3 years after programme completion), medium-term (4-9 years), and long-term (10+ years). We also conducted exploratory meta-analyses to compare effects on children's cognitive and behavioral development by these subgroups of follow-up rounds.

Results: We identified 24 articles reporting on seven randomised controlled trials of parenting interventions delivered during early childhood that had at least one follow-up study in seven LMICs. The majority of follow-up studies were in the short-term. Three trials conducted a medium-term follow-up evaluation, and only two trials conducted a long-term follow-up evaluation. Although trials consistently supported wide-ranging benefits on early child development outcomes immediately after programme completion, results revealed a general fading of effects on children's outcomes over time. Short-term effects were mixed, and medium-term and long-term effects were largely inconclusive. The exploratory meta-analysis on cognitive development found that pooled effects were significant at postintervention and in the short-term (albeit smaller in magnitude), but the effects were not significant in the medium-term and long-term. For behavioural development, the effects were consistently null over time.

Conclusions: There have been few longer-term follow-up studies of early parenting interventions in LMICs. Greater investments in longitudinal intervention cohorts are needed in order to gain a more comprehensive understanding of the effectiveness of parenting interventions over the life course and to improve the design of future interventions so they can have greater potential for achieving and sustaining programme benefits over time.
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http://dx.doi.org/10.1136/bmjgh-2020-004067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938974PMC
March 2021

Determinants and Consequences of Adolescent Fatherhood: A Longitudinal Study in Ethiopia, India, Peru, and Vietnam.

Authors:
Joshua Jeong

J Adolesc Health 2021 May 14;68(5):906-913. Epub 2020 Sep 14.

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Electronic address:

Purpose: Adolescent parenthood is a major challenge in low- and middle-income countries (LMICs). However, the vast majority of the evidence has focused on adolescent motherhood. Little is known about adolescent fatherhood in LMICs. The aim of this study was to examine the determinants of early fatherhood and its consequences on a range of outcomes among adolescent males.

Methods: This study used three waves of longitudinal data from the multicountry Young Lives cohort study, specifically following a sample of 1,779 adolescent boys at ages 15, 19, and 22 years in Ethiopia, India, Peru, and Vietnam. Individual fixed effects models were conducted to investigate the sociodemographic determinants of adolescent fatherhood and the consequences of adolescent fatherhood on males' education, health, psychosocial well-being, and time use outcomes.

Results: The results indicated that lower educational attainment, absence of the adolescent's mother and father from the home, larger household size, and poverty increased the likelihood of becoming an adolescent father by age 22 years. The results revealed that becoming an adolescent father was associated with a higher likelihood of school dropout, being overweight, smoking, greater internalizing problems, and less time spent on leisure activities and more time spent on caregiving responsibilities.

Conclusions: Highlighting the experiences of young men as adolescent parents in LMICs, findings underscore the importance of prevention strategies to delay early parenthood for adolescent boys and multicomponent interventions to support young fathers and their unique health, socioeconomic, psychosocial, and behavioral needs.
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http://dx.doi.org/10.1016/j.jadohealth.2020.08.002DOI Listing
May 2021

Maternal, paternal, and other caregivers' stimulation in low- and- middle-income countries.

PLoS One 2020 10;15(7):e0236107. Epub 2020 Jul 10.

Steinhardt, New York University and Global TIES for Children, New York City, New York, United States of America.

Background And Objectives: Globally, studies have shown associations between maternal stimulation and early child development. Yet, little is known about the prevalence of paternal and other caregivers' stimulation practices, particularly in low- and- middle-income countries (LMICs).

Methods: Data from the Multiple Indicators Cluster Survey (MICS) and the Demographic and Health Survey (DHS) were combined across 62 LMICs (2010-2018). The sample included 205,150 mothers of children aged 3 and 4 years. High levels of stimulation were defined as caregiver engagement in at least 4 out of 6 possible activities with the child. The proportion of mothers, fathers, and other caregivers providing high levels of stimulation was calculated by country, region, and for the whole sample. Socioeconomic disparities within and between countries were estimated.

Results: On average, 39.8% (95% CI 37.4 to 42.2) of mothers, 11.9% (95% CI 10.1 to 13.8) of fathers, and 20.7% (95% CI 18.4 to 23.0) of other adult caregivers provided high levels of stimulation. Stimulation varied by region, country income group, and Human Development Index (HDI), with higher levels of maternal and paternal-but not other caregivers'-stimulation in high-income and high-HDI countries. Within countries, stimulation levels were, on average, lower in the poorest relative to the richest households, and some but not all countries exhibited differences by child sex (i.e., boys vs. girls) or area (i.e., urban vs. rural).

Conclusions: Results suggest a need for intervention efforts that focus on increasing caregiver stimulation in LMICs, particularly for fathers and in low-income contexts.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236107PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7351158PMC
September 2020

Intimate Partner Violence, Maternal and Paternal Parenting, and Early Child Development.

Pediatrics 2020 06 18;145(6). Epub 2020 May 18.

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.

Background And Objectives: Previous research has demonstrated associations between maternal experience of intimate partner violence (IPV) and a range of adverse outcomes among women and their young children. However, few studies have examined the associations between maternal experience of IPV and early child development (ECD) outcomes in low- and middle-income countries (LMIC). Our objectives in this study were to examine the association between IPV victimization and ECD and assess whether the association was mediated by maternal and paternal stimulation.

Methods: We combined cross-sectional data from the Demographic and Health Surveys for 15 202 households representing mothers and fathers of children aged 36 to 59 months in 11 LMIC. We used multivariable linear regression models to estimate the association between IPV victimization in the year preceding the survey and ECD, which we measured using the Early Child Development Index. We used path analysis to determine if the association between IPV victimization and ECD was mediated through maternal and paternal stimulation.

Results: After adjusting for sociodemographic variables, IPV victimization was negatively associated with ECD (β = -.11; 95% confidence interval = -.15 to -.07). Path analysis indicated that the direct association between IPV victimization and ECD was partially and independently mediated through maternal and paternal stimulation.

Conclusions: Interventions that include components to prevent IPV may be effective for improving ECD in LMIC.
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http://dx.doi.org/10.1542/peds.2019-2955DOI Listing
June 2020

The Association Between Fathers' Depression and Children's Socioemotional Development: Evidence from a Longitudinal Household Survey in China.

Prev Sci 2020 07;21(5):672-680

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.

Depression is highly prevalent among parents around the world. Although there has been substantial research on maternal depression, few studies have additionally considered paternal depression and examined the independent and potentially interactive influence between paternal and maternal depression on children's development. The objectives of this study were to investigate the unique association between paternal depression and children's later socioemotional development, and explore whether this association was moderated by maternal depression. We used data from the 2012 and 2014 waves of the China Family Panel Studies. We used multivariable linear regression models to examine the association between paternal depression, as measured using the Center for Epidemiological Studies-Depression Scale, and children's socioemotional development, as measured using the Positive Behaviors Scale. We also explored whether there was effect modification by maternal depression. The sample comprised of 1615 children (M = 7.38 years; 48.5% female) and their parents. Twenty-four percent of fathers and 33% of mothers were depressed. We found that paternal depression was negatively associated with children's socioemotional development (β = - 0.18; 95% CI - 0.31, - 0.03), controlling for maternal depression and other sociodemographic covariates. Moreover, we found that the association was moderated by maternal depression, whereby the negative association was stronger when mothers were not depressed (β = - 0.30; 95% CI - 0.52, - 0.08) versus null when mothers were depressed (β = - 0.02; 95% CI - 0.24, 0.20). Parenting interventions should promote the mental health of fathers, in addition to mothers, as a more holistic and family-based approach for improving both the wellbeing of parents and behavioral development of children.
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http://dx.doi.org/10.1007/s11121-020-01117-3DOI Listing
July 2020

Agreement between Fathers' and Mothers' Reported Stimulation and Associations with Observed Responsive Parenting in Pakistan.

Children (Basel) 2019 Oct 15;6(10). Epub 2019 Oct 15.

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.

Parental stimulation and responsiveness are associated with improved early child development outcomes. However, the majority of studies have relied on maternal-reported measures of only mothers' parenting practices. The purpose of this study was to assess the agreement between fathers' and mothers' reports of their own and their partner's engagement in stimulation and assess the degree to which parents' reported stimulation correlated with their observed responsive caregiving behaviors. Data were collected from 33 couples (33 fathers and 32 mothers) who had a child under 5 years of age in rural Pakistan. Paternal and maternal stimulation were measured based on reports of their own and their partner's practices in play and learning activities with the child. Paternal and maternal responsiveness were observed in a subsample of 18 families. Moderate agreement was found between paternal and maternal reports of their own and their partner's practices. Moderate associations were also found between self-reported measures of stimulation and observed responsive caregiving for both fathers and mothers. The strengths of agreement and associations were greater among couples who had higher quality coparenting relationships. Findings highlight the feasibility, reliability, and promise of assessing fathers' parenting in a low-resource setting, using similar methods as for mothers' parenting, to triangulate measures between reported and observed parenting and gain a deeper understanding of fathers' and mothers' unique caregiving contributions.
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http://dx.doi.org/10.3390/children6100114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827084PMC
October 2019

Fathers' perpetration of intimate partner violence and parenting during early childhood: Results from the Fragile Families and Child Wellbeing Study.

Child Abuse Negl 2019 10 2;96:104103. Epub 2019 Aug 2.

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. Electronic address:

Background: Experiences of intimate partner violence (IPV) victimization negatively impact maternal parenting. However, little is known about the association between fathers' perpetration of IPV and paternal parenting.

Objective: To examine associations between fathers' IPV perpetration against the child's mother and fathers' stimulation and spanking practices with their young child.

Participants And Setting: We used two waves of data from the Fragile Families and Child Wellbeing Study in the United States. The analytic sample comprised of 2,257 biological fathers who had been in a romantic relationship with the child's mother.

Methods: Fathers' IPV perpetration at year 1 and 3 was measured based on maternal report. Fathers were categorized into: never perpetrators (no IPV at either year), persisters (IPV at both years), desisters (IPV at year 1 only), and emergers (IPV at year 3 only). Fathers' parenting at year 3 was measured based on self-reported stimulation (e.g., reading books, playing games, telling stories) and spanking.

Results: Approximately one-third of fathers never perpetrated IPV, 35.8% were persisters, 14.4% were desisters, and 16.9% were emergers. For stimulation, persisters (β=-0.16, 95% CI: -0.25, -0.06) and emergers (β=-0.25, 95% CI: -0.36, -0.14), but not desisters (β=-0.02, 95% CI: -0.14, 0.11), were less engaged in stimulation than fathers who never perpetrated IPV. However, for spanking, there were no differences in the associations by father IPV profiles.

Conclusions: Findings suggest that fathers' perpetration of IPV is related to their stimulation practices. Partner-abusive men and their children may benefit from parenting programs that promote engagement in stimulation and improve the quality of parent-child relationships.
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http://dx.doi.org/10.1016/j.chiabu.2019.104103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761008PMC
October 2019

Correction to: "His mind will work better with both of us": a qualitative study on fathers' roles and coparenting of young children in rural Pakistan.

BMC Public Health 2018 12 6;18(1):1350. Epub 2018 Dec 6.

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, 11th floor, Boston, MA, USA.

After publication of the original article [1], the authors wanted to make an amendment in the Acknowledgments section as Muneera Rasheed requested to be removed. This correction article shows the original and revised version of the "Acknowledgments". The original article was not updated.
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http://dx.doi.org/10.1186/s12889-018-6271-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6282395PMC
December 2018

"His mind will work better with both of us": a qualitative study on fathers' roles and coparenting of young children in rural Pakistan.

BMC Public Health 2018 Nov 20;18(1):1274. Epub 2018 Nov 20.

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, 11th floor, Boston, MA, USA.

Background: Parents are the primary providers of nurturing care for young children's healthy early development. However, the literature on parenting in early childhood, especially in low- and middle-income countries, has primarily focused on mothers. In this study, we investigate how parents make meaning of fathers' parenting roles with regards to their young children's early health and development in rural Pakistan.

Methods: Data were collected between January and March 2017 through in-depth interviews with fathers (N = 33) and their partners (N = 32); as well as separate focus group discussions with fathers (N = 7) and mothers (N = 7). Data were analyzed using thematic content analysis.

Results: Parents described a distinct division of roles between fathers and mothers; and also several shared caregiving roles of fathers and mothers. Specifically, parents highlighted aspects of fathers' coparenting and several common ways by which fathers supported their partners. We found that these gendered divisions in parenting roles were strongly embedded within a complex network of interacting factors across the individual, family, and sociocultural contexts of the study community.

Conclusions: Our findings suggest a more family-centered conceptualization of fatherhood during early childhood that encompasses both fathers' direct engagement with their young children and their indirect contributions through coparenting, while recognizing a variety of contextual systems that shape paternal parenting. Future parenting interventions that reflect the lived experiences of both fathers and mothers as parents and partners may further enhance the nurturing care environments that are critical for promoting healthy early child development.
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http://dx.doi.org/10.1186/s12889-018-6143-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245824PMC
November 2018

Associations between birth registration and early child growth and development: evidence from 31 low- and middle-income countries.

BMC Public Health 2018 05 30;18(1):673. Epub 2018 May 30.

Swiss Tropical and Public Health Institute, Basel, Switzerland.

Background: Lack of legal identification documents can impose major challenges for children in low- and middle-income countries (LMICs). The aim of this study was to investigate the association between not having a birth certificate and young children's physical growth and developmental outcomes in LMICs.

Methods: We combined nationally representative data from the Multiple Indicator Cluster Surveys in 31 LMICs. For our measure of birth registration, primary caregivers reported on whether the child had a birth certificate. Early child outcome measures focused on height-for-age z-scores (HAZ), weight-for-age z-scores (WAZ), weight-for-height z-scores (WHZ), and standardized scores of the Early Childhood Development Index (ECDI) for a subsample of children aged 36-59 months. We used linear regression models with country fixed effects to estimate the relationship between birth registration and child outcomes. In fully adjusted models, we controlled for a variety of child, caregiver, household, and access to child services covariates, including cluster-level fixed effects.

Results: In the total sample, 34.7% of children aged 0-59 months did not possess a birth certificate. After controlling for covariates, not owning a birth certificate was associated with lower HAZ (β = - 0.18; 95% CI: -0.23, - 0.14), WAZ (β = - 0.10, 95% CI: -0.13, - 0.07), and ECDI z-scores (β = - 0.10; 95% CI: -0.13, - 0.07) among children aged 36-59 months.

Conclusion: Our findings document links between birth registration and children's early growth and development outcomes. Efforts to increase birth registration may be promising for promoting early childhood development in LMICs.
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http://dx.doi.org/10.1186/s12889-018-5598-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977554PMC
May 2018

Stimulation Interventions and Parenting in Low- and Middle-Income Countries: A Meta-analysis.

Pediatrics 2018 04 2;141(4). Epub 2018 Mar 2.

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; and.

Context: Early childhood stimulation interventions positively impact early child development (ECD) outcomes in low- and middle-income countries. However, trials have less comprehensively evaluated the effects of such parenting programs on caregivers' skills and capacities.

Objective: We conducted a systematic review and meta-analysis to assess the effectiveness of stimulation interventions on improving parenting outcomes.

Data Sources: Six electronic bibliographic databases.

Study Selection: Inclusion criteria included randomized controlled trials of stimulation interventions designed to improve ECD outcomes during the first 2 years of life that measured any maternal or parenting-related outcome after the start of the intervention.

Data Extraction: Two independent reviewers extracted data by using a structured form.

Results: Fifteen studies representing 13 unique randomized controlled trials met the inclusion criteria. Pooled standardized mean differences (SMDs) based on random-effects models revealed medium-to-large benefits of stimulation interventions for improving the home caregiving environment ( = 10; SMD = 0.57; 95% confidence interval [CI], 0.37 to 0.77), mother-child interactions ( = 3; SMD = 0.44; 95% CI, 0.14 to 0.74), and maternal knowledge of ECD ( = 6; SMD = 0.91; 95% CI, 0.51 to 1.31). No significant difference was seen for maternal depressive symptoms ( = 9; SMD = -0.10; 95% CI, -0.23 to -0.03).

Limitations: Limitations include heterogeneity across interventions, lack of standardized measures, and different time points of assessments across studies.

Conclusions: Early childhood stimulation interventions improve several distinct aspects of maternal parenting. Improvements in parenting capacities may serve as key mechanisms by which these programs benefit ECD outcomes.
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http://dx.doi.org/10.1542/peds.2017-3510DOI Listing
April 2018

How consistent are associations between maternal and paternal education and child growth and development outcomes across 39 low-income and middle-income countries?

J Epidemiol Community Health 2018 05 8;72(5):434-441. Epub 2018 Feb 8.

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.

Background: Maternal and paternal education are associated with improved early child outcomes. However, less is known about how these relative associations compare for preschool children's growth versus development outcomes; and across country contexts.

Methods: We analysed data from 89 663 children aged 36 to 59 months in 39 low-income and middle-income countries (LMICs). We used linear regression models with country fixed effects to estimate the joint associations between maternal and paternal education and children's growth and development outcomes. Additionally, we examined the variability in these relationships by each country and within subgroups of countries.

Results: In the pooled sample, maternal and paternal education were independently associated with 0.37 (95% CI 0.33 to 0.41) and 0.20 (95% CI 0.16 to 0.24) higher height-for-age z-scores, and 0.31 (95% CI 0.29 to 0.34) and 0.16 (95% CI 0.14 to 0.18) higher Early Childhood Development Index z-scores, respectively (comparing secondary or higher to no education). Associations were stronger for maternal education than paternal education but comparable between child outcomes. In country-specific regressions, we found the most heterogeneity in the associations between maternal education and children's growth; and between paternal education and children's development. Subgroup analyses suggested that these associations may be systematically patterned by country-level adult illiteracy, infant mortality and food insecurity.

Conclusion: Our findings highlight variability in the statistical significance and magnitude of the associations between caregivers' education and children's outcomes. Further research is needed to understand the sources of variation that may promote or constrain the benefits of caregivers' education for children's early health and development in LMICs.
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http://dx.doi.org/10.1136/jech-2017-210102DOI Listing
May 2018

Molecular Mechanisms for CFIm-Mediated Regulation of mRNA Alternative Polyadenylation.

Mol Cell 2018 01 21;69(1):62-74.e4. Epub 2017 Dec 21.

Department of Microbiology and Molecular Genetics, School of Medicine, University of California, Irvine, Irvine, CA 92697, USA. Electronic address:

Alternative mRNA processing is a critical mechanism for proteome expansion and gene regulation in higher eukaryotes. The SR family proteins play important roles in splicing regulation. Intriguingly, mammalian genomes encode many poorly characterized SR-like proteins, including subunits of the mRNA 3'-processing factor CFIm, CFIm68 and CFIm59. Here we demonstrate that CFIm functions as an enhancer-dependent activator of mRNA 3' processing. CFIm regulates global alternative polyadenylation (APA) by specifically binding and activating enhancer-containing poly(A) sites (PASs). Importantly, the CFIm activator functions are mediated by the arginine-serine repeat (RS) domains of CFIm68/59, which bind specifically to an RS-like region in the CPSF subunit Fip1, and this interaction is inhibited by CFIm68/59 hyper-phosphorylation. The remarkable functional similarities between CFIm and SR proteins suggest that interactions between RS-like domains in regulatory and core factors may provide a common activation mechanism for mRNA 3' processing, splicing, and potentially other steps in RNA metabolism.
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http://dx.doi.org/10.1016/j.molcel.2017.11.031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756121PMC
January 2018

Paternal Stimulation and Early Child Development in Low- and Middle-Income Countries.

Pediatrics 2016 10 6;138(4). Epub 2016 Sep 6.

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Background And Objective: Few studies have examined the relationship between paternal stimulation and children's growth and development, particularly in low- and middle-income countries (LMICs). This study aimed to estimate the prevalence of paternal stimulation and to assess whether paternal stimulation was associated with early child growth and development.

Methods: Data from the Multiple Indicator Cluster Surveys rounds 4 and 5 were combined across 38 LMICs. The sample comprised 87 286 children aged 3 and 4 years. Paternal stimulation was measured by the number of play and learning activities (up to 6) a father engaged in with his child over the past 3 days. Linear regression models were used to estimate standardized mean differences in height-for-age z-scores and Early Childhood Development Index (ECDI) z-scores across 3 levels of paternal stimulation, after controlling for other caregivers' stimulation and demographic covariates.

Results: A total of 47.8% of fathers did not engage in any stimulation activities, whereas 6.4% of fathers engaged in 5 or 6 stimulation activities. Children whose fathers were moderately engaged in stimulation (1-4 activities) showed ECDI scores that were 0.09 SD (95% confidence interval [CI]: -0.12 to -0.06) lower than children whose fathers were highly engaged; children whose fathers were unengaged showed ECDI scores that were 0.14 SD lower (95% CI: -0.17 to -0.12). Neither moderate paternal stimulation nor lack of paternal stimulation was associated with height-for-age z-scores, relative to high stimulation.

Conclusion: Increasing paternal engagement in stimulation is likely to improve early child development in LMICs.
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http://dx.doi.org/10.1542/peds.2016-1357DOI Listing
October 2016

Associations between Mental Health and Ebola-Related Health Behaviors: A Regionally Representative Cross-sectional Survey in Post-conflict Sierra Leone.

PLoS Med 2016 08 9;13(8):e1002073. Epub 2016 Aug 9.

Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America.

Background: Little attention has been paid to potential relationships between mental health, trauma, and personal exposures to Ebola virus disease (EVD) and health behaviors in post-conflict West Africa. We tested a conceptual model linking mental health and trauma to EVD risk behaviors and EVD prevention behaviors.

Methods And Findings: Using survey data from a representative sample in the Western Urban and Western Rural districts of Sierra Leone, this study examines associations between war exposures, post-traumatic stress disorder (PTSD) symptoms, depression, anxiety, and personal EVD exposure (e.g., having family members or friends diagnosed with EVD) and EVD-related health behaviors among 1,008 adults (98% response rate) from 63 census enumeration areas of the Western Rural and Western Urban districts randomly sampled at the height of the EVD epidemic (January-April 2015). Primary outcomes were EVD risk behaviors (14 items, Cronbach's α = 0.84) and EVD prevention behaviors (16 items, Cronbach's α = 0.88). Main predictors comprised war exposures (8 items, Cronbach's α = 0.85), anxiety (10 items, Cronbach's α = 0.93), depression (15 items, Cronbach's α = 0.91), and PTSD symptoms (16 items, Cronbach's α = 0.93). Data were analyzed using two-level, population-weighted hierarchical linear models with 20 multiply imputed datasets. EVD risk behaviors were associated with intensity of depression symptoms (b = 0.05; 95% CI 0.00, 0.10; p = 0.037), PTSD symptoms (b = 0.10; 95% CI 0.03, 0.17; p = 0.008), having a friend diagnosed with EVD (b = -0.04; 95% CI -0.08, -0.00; p = 0.036), and war exposures (b = -0.09; 95% CI -0.17, -0.02; p = 0.013). EVD prevention behaviors were associated with higher anxiety (b = 0.23; 95% CI 0.06, 0.40; p = 0.008), having a friend diagnosed with EVD (b = 0.15; 95% CI 0.04, 0.27; p = 0.011), and higher levels of war exposure (b = 0.45; 95% CI 0.16, 0.74; p = 0.003), independent of mental health. PTSD symptoms were associated with lower levels of EVD prevention behavior (b = -0.24; 95% CI -0.43, -0.06; p = 0.009).

Conclusions: In post-conflict settings, past war trauma and mental health problems are associated with health behaviors related to combatting EVD. The associations between war trauma and both EVD risk behaviors and EVD prevention behaviors may be mediated through two key mental health variables: depression and PTSD symptoms. Considering the role of mental health in the prevention of disease transmission may help fight continuing and future Ebola outbreaks in post-conflict Sierra Leone. This sample is specific to Freetown and the Western Area and may not be representative of all of Sierra Leone. In addition, our main outcomes as well as personal EVD exposure, war exposures, and mental health predictors rely on self-report, and therefore raise the possibility of common methods bias. However, the findings of this study may be relevant for understanding dynamics related to EVD and mental health in other major capital cities in the EVD-affected countries of West Africa.
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http://dx.doi.org/10.1371/journal.pmed.1002073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978463PMC
August 2016