FACTORS PREDICTING MENTAL DEVELOPMENT FOR LOW-INCOME MINORITY TODDLERS

1. FACTORS PREDICTING MENTAL DEVELOPMENT FOR LOW-INCOME MINORITY TODDLERS

2. Kathleen F. Norr, PhD Kathleen S. Crittenden, PhD Kaoru Watanabe, MS, RN Seijeoung Kim, PhD, RN* University of Illinois at Chicago *Hektoen Research Institute

3. Acknowledgements This research was funded by AHCPR, NINR, University of Illinois at Chicago (Medical Center, College of Nursing, Great Cities Institute, and Center for Research on Women and Gender).

4. ABSTRACT PROBLEM: To examine the influences of maternal demographics, household factors, depression, and cognitive growth fostering (HOME scores) on mental development over the first two years of life for African American and Mexican American low-income toddlers in urban communities. METHOD: Data come from a longitudinal clinical trial examining the impact of a home visiting program for 435 low-income inner city African American and Mexican American women from prenatal intake to 24 months after birth. Guided by an ecological model, we used hierarchical regression with time nested in individuals to predict infant mental development at 12, 18 and 24 months. We examined the effect of time-constant infant, mother, household and services factors and time-varying parenting environment factors. RESULTS: Mental development (Bayley II Mental Development Index–MDI) scores declined over time. Home environment factors related to MDI scores: the HOME assessment of cognitive-growth fostering related positively and maternal depression related negatively, while contact with the baby’s father was not significantly related. When parenting environment factors are not controlled for, MDI scores were higher for girls than boys, for mothers who were Mexican Americans, having their first baby, and high school graduates, and in households with fewer children under 6. After parenting environment factors are added, maternal education no longer affects MDI scores, and being in the home visiting intervention also relates to more positive scores. This study shows that more attention is needed to foster mental development of medically low-risk infants from low-income families. Public policy and programs should focus on enhancing parenting skills, identifying and reducing maternal depression, and encouraging young women to complete their education before childbearing.

5. Purpose To examine factors that predict mental development of toddlers at 12M, 18M, and 24M, including: • Child sex • Maternal demographics • Household (HH) factors • Services • Parenting Environment

6. Data • Data come from a longitudinal clinical trial assessing the impacts of a home visiting program (REACH-Futures). • 435 low-income, medically low-risk mother-child dyads, who resided in Chicago’s high-risk neighborhoods: • 298 African Americans • 137 Mexican Americans

7. Ecological Framework • Child Factor: • Sex • Maternal Factors: • Race/Ethnicity • Education • Parity • Household Factors: • # of children < 6Y • Any HH member worked • last 12M • Services: • AFDC within 6M of birth • REACH-F up to 12M • Parenting • Environment: • Depression • Growth • fostering • environment • Contact with • child’s father • Child • Outcome: • Mental • development

8. Sample Characteristics

10. Analyses • Hierarchical regression with time nested within individuals • Random intercept model • Time-varying parenting environment factors: • Treated as mediators of non time-varying background factors • MDI lagged by 6M

11. Dependent Variable: Mental Development Measured @ 12M, 18M, and 24M • Bayley II Infant Mental Development Index (MDI) • Standardized scores based on national age-specific norms • Mean=100 • SD=15

12. Background Factors • Measured @ Intake • Child’s sex • Mother’s race/ethnicity • Education • Parity • # of children <6Y in HH • Any HH member worked last 12M • AFDC within 6M of birth • REACH-F

13. Parenting Environment Factors Measured @ 6M, 12M, and 18M • Depression: CES-D • Growth-fostering environment: Home Observation for Measurement of the Environment (HOME) • Contact with child’s father (no contact, regular contact, or live with child’s father)

14. Mental Development Over Time by Race/Ethnicity Mexican American African American

15. Depression Over Time by Race/Ethnicity Mexican American African American

16. HOME Scores Over Time by Race/Ethnicity Mexican American African American

17. Contact with Child’s Father Over Time by Race/Ethnicity Live w/ father Regular contact African American Mexican American

18. Regression Equation for Predicting MDI **p < .01; *p < .05

19. Predicting MDI: Time and Parenting Environment • Declines over time • Positively related to HOME scores • Negatively related to CES-D • Not related to contact with child’s father

20. Not Controlling for Parenting Environment Declines over time Higher for: Mexican American mother HS educated mother Girl child Fewer children < 6Y in HH Predicting MDI: Background Factors

21. Effects Controlling for Parenting Environment • Effects unchanged: • Time • Mexican American mother • Girl child • Fewer children <6Y in HH • Effects changed: • Mother’s education no longer predicts MDI • REACH-F becomes positive effect

22. Predicting Parenting Environment: CES-D • Higher for multipara mother • Lower for: • HS educated mother • Any HH member worked last 12M • Negatively Related to # of Children < 6 in HH

23. Predicting Parenting Environment: HOME • Increases over time • Higher for: • Mexican American mother • HS educated mother • Not on AFDC

24. Conclusions Mental Development of Toddlers from Low-income Families: • Close to national norms at 12M • Decline in second year of life • Decline more pronounced for African American children with 24M mean scores .67 SD below average

25. Results Generally Support the Ecological Model: • Parenting environment factors affect mental development. • Maternal depression has negative effect on growth fostering home environment. • Effect of mother’s education is mediated by parenting environment. • Background factors that continue to have a direct effect include race/ethnicity, child’s sex, and # young children in HH.

26. Policy Implications • Low-SES families need help to improve the parenting environment for their young children. • Healthy children at socioeconomic risk are often ineligible for current child development services. • Interventions should begin in the first two years to prevent developmental lags.

27. Education has important non-economic benefits for young women and their future children. • More attention must be given to depression among young women. • Such attention would also benefit children. • Public policy should be directed to improving parenting skills and life circumstances of low-income women.