With this dissertation, we set out to explore the relationship between
environmentalheat and select childhealthoutcomes in the United States. The first study, overall,found little to no short-term association between maternal heat wave exposure and preterm birth in Massachusetts, using five definitions of heat wave. However, stratified analyses revealed potential increases in risk at earlier gestational ages and at less extreme levels of heat, which should be explored in future studies. Findings from the second study provided some evidence for increased rates of emergency department (ED) visits for asthma among Massachusetts children during and immediately following heat waves, although excess numbers were small. Additionally, slightly elevated rates for all-cause pediatric ED visits during heat waves corresponded to hundreds and even thousands of excess visits when lag days were considered. Finally, the third study confirmed elevated rates of salmonellosis in the summer compared to winter among infants in the U.S. and revealed a greater absolute impact compared to other age groups, especially among infants in the South and for serotypes commonly from environmental, non-food sources.
the first detailed evidence on other features of family and community vulnerability associated with injury in Aboriginal children, which can inform targeted prevention. Family and community wellbeing were protective against child injury in this sample; indicators of better life circumstances and safe neighbourhoods were associated with a 20– 30% lower prevalence of ever-injury. Children were significantly less likely to have ever been injured if their caregiver had better social and emotional wellbeing and had not served time in prison, if their family experienced fewer major life events in the past year, and if they were not exposed to alcohol misuse in the household or theft in the community. The relationship of caregivers’ social and emotional wellbeing to child injury demonstrates the importance of parental wellbeing to childhealthoutcomes, and lends support to the existing programs and services delivered by ACCHSs to support caregivers’ wellbeing. Given the established relationship between the wellbeing of Aboriginal children and their caregivers, 27 the
hand, there is empirical literature which finds no evidence that such poli- cies are significantly affected by the gender of politicians. Theoretical lit- erature also has diverging arguments on the importance of the identity of the politician, gender included, in shaping the allocation of resources across spending categories. In contrast to Down’s(1957) Median Voter Theorem, Citizen Candidate Models of Besley and Coate (1997) and Os- borne and Slivinski (1996) support the fact that the identity and prefer- ences of a politician matters for the implementation of a policy. According to the Median Voter Theorem(Dow57), if the politicians only care about winning the elections and commit to implementing specific policies once elected, majority rule applies and policy decisions should only reflect the preferences of the median voter rather than the preferences of the politi- cian. However, if the candidates could not commit to specific policies, the identity of the politician matters for policy implementation(OS96; BC97). Based on the theory of Citizen Candidate Models which support the fact that the identity of a politician matters for the policy determination, this chapter firstly has aimed to contribute to the strand of empirical lit- erature by studying the relationship between female political representa- tion and public spending on famliy allowances across OECD Countries. Public spending on family allowances is one of the family-specific poli- cies that plays an important role in helping families for the childcare and child raising which the literature suggests is one of the woman’s primary concerns. The preliminary result of this chapter is the lack of a relation- ship between the female political participation and public spending on family allowances can be interpreted in three ways. 1-The result might be consistent with the Median voter theorem, rather than Citizen Can- didate Models, suggesting that politicians’ preferences and identities do not matter in public policy making. 2- Preferences and the gender iden- tity of the politicians might still matter for the policy determination but the preferences of the women who involved in political activities might be close to those of their male colleagues. 3- Gender identity of the politi- cian might matter but the insignificance of the female political participa- tion in policy-decision making may depend on the under-representation of women in political institutions.Namely, the role of female politicians
Researchers should seize on the emerging recognition of the impor- tance of literacy for childhealth out- comes. We need to expand our under- standing of the relative roles of caregiver and child literacy. Studies to identify the key health literacy skills needed by children as they transition to self-management can lead to better curricula for clinician training and pri- mary and secondary schools. We need a better understanding of the relation- ship between knowledge and behav- iors so that our interventions can af- fect behaviors that are most closely associated with positive health out- comes. Finally, interventions should improve outcomes for all patients but also narrow the gap in outcomes be- tween people with low and higher literacy.
In chapter five, an analysis was presented to investigate the relationship between health resources and the utilization of maternal health services between poor and non- poor areas in Brazil in 2000. Using data from the 5,507 Brazilian municipalities, a production function approach was used to investigate the relationship between the sup- ply of health workers (physicians, nurse professionals, nurse associates and community health workers), health facilities (ambulatory units, hospitals and hospital beds), quality indicators in the form of private (versus public) provision, salary levels and other covari- ates, with access to antenatal care and attended deliveries between poor and non-poor areas. A seemingly unrelated Tobit regression model with corner solution application was used for this purpose. This study found great inequalities in maternal and childhealth services, poorer municipalities had lower proportions of deliveries attended in health facilities and proportions of pregnant women covered by antenatal care than richer municipalities. When looking at the multivariate relationships it was found that utilization of maternal and childhealth services rises with the provision of facilities and health workers. In poor municipalities utilization also rises with local access to facilities, private rather than public provision of services and highly qualified health workers. Population health/ impact outcomes
consistent with a “for better and for worse” interaction pattern. Evidence in support of the genetic basis of environmental sensitivity is predominately drawn from gene by environment interaction (GxE) studies. Such studies typically test whether specific genetic variants (e.g. 5-HTTLPR) interact with environmental risk factors (e.g. childhood maltreatment) in the prediction of an outcome (e.g. depression). Comprehensive reviews of GxE literature by Belsky and Pluess (2009, 2013a), and subsequent research using the differential susceptibility framework, have identified a number of genetic variants as markers of environmental sensitivity (see Chapter 4, Section 184.108.40.206). For example, the short allele of the 5-HTTLPR and the DRD4 7-repeat allele have been consistently found to influence psychological outcomes not only “for worse”, in response to adversity, but also “for better”, at the positive ‘end’ of the environmental quality spectrum (For meta-analysis of studies with these variants, see: Bakermans-Kranenburg & van IJzendoorn, 2011; van IJzendoorn, M. H. et al., 2012). The 5-HTTLPR short allele has, for instance, been found to moderate the impact of maternal responsiveness on children’s moral development (Kochanska et al., 2011), the effect of child maltreatment on children’s antisocial behavior (Cicchetti et al., 2012) and the benefit of supportive parenting on child positive affect (Hankin et al., 2011), both for better and for worse. There are, however, at least two caveats that have to be considered when interpreting research findings from GxE studies as evidence for the genetic basis of environmental sensitivity. First, such studies indicate that these genetic factors moderate the impact of the examined environmental influences on the measured outcomes, but they have not been tested for their direct associations with individual differences with phenotypic environmental sensitivity. Therefore, it is difficult to determine whether these genes are relevant for the aetiology of the environmental sensitivity phenotype, an empirical question that is the focus of Chapter 4. Second, even if we were to assume that these genetic factors are relevant for the aetiology of phenotypic environmental sensitivity, these GxE results do not provide an estimate of how much of the variability in environmental sensitivity might be explained by genetic influences. Examining the heritability of environmental sensitivity is therefore an important first step.
Currently, most studies have focused primarily on one or two healthoutcomes at a time, only one domain of health such as mental health, or only global measures of per- ceived health. These studies are useful and provide valua- ble specific information related to these outcomes. However, there is also some benefit and utility in examin- ing the association between a consistent set of social deter- minants and various childhealthoutcomes using the same set of independent variables. Every mental and physical illness has its unique clinical differences, differ- ent strategies for management, and its underlying mecha- nisms may account for observed differences in the effect of a specific determinant . For example, outcomes that are influenced by behavioural or environmental factors might be expected to be more sensitive to income levels, compared to outcomes with genetic or non-modifiable causes. By looking at several key outcomes and identifying the associations with the same set of core (and often cited) determinants, one can gauge the impact of income for example, across key childoutcomes. This is relevant espe- cially from a policy perspective. If it can be shown that a social determinant is constantly associated across multi- ple outcomes and that the association is consistently in the same direction, it would lead to greater justification for targeting that social determinant in any health promo- tion campaign. On the other hand, if the results for a cer- tain factor are mixed across key childhealthoutcomes, the findings would suggest a more diversified approach spe- cific to each health outcome.
Data for this study was drawn from a larger, ongoing longitudinal project concerning maternal depression and child emotional development. Participants were recruited from the local community surrounding the Columbus, OH area. Mothers with young children were recruited though local newspapers, online ads, flyers sent to local daycare centers and mental health clinics, and flyers posted at community centers on or close to a university campus. A brief, phone screening questionnaire was used to determine eligibility and collect maternal history of depression information. Mothers met eligibility criteria if they 1) were 21 years of age or older; 2) had a child between 3 and 3.5 years; and 3) had not been diagnosed with psychiatric disorders other than depression (with or without co-occurring anxiety disorders). Children were excluded from participation if they had been diagnosed with a developmental delay.
Gibson et al., (1998) contribute to this debate and argue that children’s consumption of fruit and vegetables are related to different psychosocial and environmental factors and promotion of this behavior requires attention to nutrition education and child feeding strategies of parents. The study finds mother’s nutrition knowledge strongly correlated to their children’s fruit intake. Children’s vegetable consumption was independently explained by the child’s liking for commonly eaten vegetables and mother’s belief in the importance of disease protection when choosing her child’s food. On the other hand children’s consumption of confectionary was predicted by the mother’s liking for confectionary and the childrren’s concern for health in choosing what to eat. We also acknowledge the extensive literature on childhealth which has reported significant gender differences in male and female childhealthoutcomes. A number of studies find that the health of male children is more vulnerable than that of female children. Wamani et al. (2004), find that more boys than girls were significantly stunted in poorer than in wealthier socio-economic strata in Hoima district of Uganda. The study reveals that the magnitude of the difference in stunting between boys and girls did not only diminish with improvements in socio-economic status but also varied with mother’s education level. Mothers with no formal education were significantly more likely to have more boys stunted than their counterparts with education above primary.
number of heat-related illness cases. This result aligns with previously published papers. Basu et al.  re- ported high ED heat-related illness risk (393.3%) during high temperature days. Ostro et al.  similarly showed an increase in heat stroke hospitalizations (166%) per 10 °F change in maximum temperature. The other four disease categories, however, showed a less consistent as- sociation with maximum temperature. For dehydration, Duval, Hillsborough, and Miami-Dade County showed positive relationship with maximum temperature whereas Leon and Orange County did not show any sig- nificant relationships. We also found a positive relation- ship between renal illness cases and maximum temperature in Duval and Miami-Dade County. On the other hand, Hillsborough, Leon, and Orange County did not show any significant temperature associations. We suspect the relationships reflected demographic charac- teristics of each county. Some types of illnesses such as renal and cardiovascular illness are more common with advanced age. They tend to be more sensitive to high temperature due to degraded organ functions and high prevalence of chronic and degenerative diseases. Rela- tively younger median ages in Leon and Orange County could be one reason for insignificant association with maximum temperature. In addition, our study’s ED/ hospitalization dataset does not capture heat-related ill- ness from tourists whose billing address is outside of the state. Thus, heat-related illness may be underreported from Orange County which hosts many theme parks fre- quented by domestic and international tourists.
Recognition of the need to address the social determi- nants of health has led to innovative mechanisms to improve the quality of outcomes in childhealth being developed. The development of strategic partnerships between service providers from different sectors and the community is central to many of these innovations. The characteristics of these partnerships are well captured in the following terms. "Partnership is a dynamic relation- ship among diverse actors, based on mutually agreed objectives, pursued through a shared understanding of the most rational division of labour based on the respec- tive comparative advantages of each partner. Partnership encompasses mutual influence, with a careful balance between synergy and respective autonomy, which incor- porates mutual respect, equal participation in decision- making, mutual accountability, and transparency"  (p.216).
and illnesses parameters, with the exception of time since the child’s last medical crisis, were generally unrelated to caregivers’ health. Although the DSC model seemed to function well in relation to caregivers’ negative healthoutcomes, revisions are needed in the way that researchers and clinicians may use the DSC model to understand parents’ perceived benefit from their caregiving situation. Findings from this research suggest that interventions should seek to improve caregivers’ perceived social support and decreased their perceived stress. One way to do this is to open support interventions to a range of caregivers whose children have different diagnoses but who are similarly burdened or distressed by their caregiving experience. It is also important to note that parents may perceive benefit from their experience of caring for a child with a CHC and that there is more to their role as a caregiver than burden and distress. Helping caregivers to remember the benefit they may experience and helping them to decrease their felt burden or distress would ultimately lead to improved health and well-being for children and whole families, not to mention the individual parent. Regardless of the study findings, it is important for future research to investigate how a more diverse, representative sample of mothers and fathers of all races, ethnicities, marital statuses, and education and income levels are
Corporal punishment is here defined as “the use of physical force with the intention of causing a child to experience pain, but not injury, for the purpose of correction or control of the child’s behavior” (Straus & Stewart, 1999, p. 57). Compelling evidence has accumulated that corporal punishment is directly associated with negative outcomes in children, even as it may increase children’s short-term compliance. In their meta-analytic reviews, Gershoff (2002a) and Ferguson (2013) reported small to moderate associa- tions between more corporal punishment and higher externalizing and internalizing behaviors, lower quality relationships, and poorer mental health in childhood and adulthood. Such associations between corporal punishment, negative child behaviors, and poor psychological adjustment are evident across cultural and ethnic groups (e.g., Gershoff, Lansford, Sexton, Davis-Kean, & Sameroff, 2012; Lansford et al., 2005; McLoyd & Smith, 2002), in cross- lagged, transactional analyses within-time and across age in child- hood (e.g., Berlin et al., 2009; Choe, Olson, & Sameroff, 2013; Maguire-Jack, Gromoske, & Berger, 2012), and through to early adolescence (MacKenzie, Nicklas, Brooks-Gunn, & Waldfogel, 2015). Gershoff and Grogan-Kaylor (2016) report in a recent meta-analysis that the associations between spanking and detrimen- tal child and adult outcomes were robust across variations in mea- sures, raters, time periods, and countries, and in both cross-sectional and longitudinal designs.
In light of the fact that natural disasters are projected to become more common in Africa due to climate change Dinkelman (2017) investigates the effects of droughts on long run differences in human capital measured as disability. Her research exploits a quasi-random variation in exposure to many local droughts in different districts in South Africa. The model uses data from the 1996 census report among South African homelands during apartheid and investigates later life disability rates between the districts with control variables for birth year and district. Data from the census report and drought data are merged into a sample by using district and year of birth. She argues that local rainfall is a relevant measure of an important environmental shock in South Africa since maize is the staple food in the country. Furthermore, maize yields are vulnerable to droughts or insufficient rainfall and maize is more sensitive to low levels of rainfall compared to excess of rain. The main result is that exposure to drought in early childhood (before 4 years of age) significantly raises the risk of having a severe disability later on in life. The measured effects were even larger in the sub-sample of males compared to females, suggesting a gender aspect. The research design of my paper has been inspired by Dinkelman (2017), but there are several differences between our papers. First, I focus on Zimbabwe not South Africa and my outcome variable is height-for age (chronic malnutrition) rather than later-life disability. Furthermore, Dinkelman (2017) uses the SPI as her measure of drought whereas I use the SPEI, the main advantage to the SPEI is that it takes into account the importance temperature on drought conditions unlike the SPI (a more detailed explanation of the drought variable can be found in chapter three).
Studies have presented relation between increasing temperatures and rise in hospital admissions for mental, mood and behavioural disorders (Trang et al., 2016), due to symptomatic mental disorders, dementia, mood disorders, stress- associated disorders, somatoform disorders, psychological development disorders, schizophrenia, mania, neurotic disorders, self-injury, and intentional injury ((Basu et al., 2017; Wang & Horton, 2015; Chand & Murthy, 2008; Hansen et al., 2008). Heat waves are found to potentiate risk for hospital admission due to mental disorders especially among elderly individuals (senility), men and people from rural communities (Trang et al., 2016; Hansen et al., 2008).
A limitation to our efforts is the small number of genes associated with chemicals in the Tox21 gene library. We propose that our integration efforts can be used to inform inclusion of additional assays to increase coverage of biomedical disease domains. For example, there are 19,216 genes associated with PD that are curated in CTD but were not assayed in HTS data. By using this set of genes to search for assays in resources such as the PubChemBioAssay Database, new assays could be identified targeting these PD-associated genes. Additional efforts could be focused on identifying assays for disease domains with less existing chemical-gene association data across either database (Figure 3.3). Further, while our study has focused on the utility of our strategy to identify associations between toxicants and adverse outcomes, our method can also be applied to identify new therapeutic routes for chemical-gene-pathway-disease connections. As we demonstrated, the chemical-gene activity for a toxicant can be identified from the HTS chemical-gene data and linked to the pathway-disease data from the union dataset. Therefore, a potential therapeutic may be characterized by identifying drugs that are associated with the same pathway-disease mechanisms but exhibiting opposite activity.
34 may not fully reflect the parents’ investment. Next, more time-varying controls variables are necessary, especially those that reflect parents characteristics and preferences in fertility and child-raising. These variables can serve as nice controls that may further help in controlling for endogeneity between family size and healthoutcomes since they also affect both variables. In addition, the models do not examine the same children, due to missing data in healthoutcomes and other variables. Due to this, not all analyses made can be applied to a general population since they are conclusions made about different subsets of the sample. Lastly, my models fail to acknowledge any interaction between siblings that may affect childhealth. For instance, older siblings may take on the some parental roles for the younger children. Although physical resources may be constrained by an additional child, having an older sibling supervise the younger child while being active outside may have a positive externality on healthoutcomes. This aspect of the family must be taken accounted in the regressions in order to pry out the causal effect of family size more accurately.
Dr Owino drafted the initial manuscript, wrote the conclusion, formatted the manuscript to conform to Pediatrics style, and reviewed and revised the manuscript; Dr Ahmed wrote the section on emerging approaches for prevention and treatment of environmental enteric dysfunction (EED), and reviewed and revised the manuscript; Dr Freemark wrote the section on growth failure and stunting in malnutrition and EED and edited the manuscript; Dr Kelly wrote the section on pathobiology of EED and contributed to Future Directions, and reviewed and revised the manuscript; Dr Loy wrote the section on the diagnostic potential of stable isotope assays, and reviewed and revised the manuscript; Dr Manary wrote the section on application of –“-omic” technology in EED diagnosis, contributed to Future Directions, and reviewed and revised the manuscript; Dr Loechl conceptualized and facilitated discussions for the perspective, and reviewed and revised the manuscript; and all authors approved the ﬁ nal manuscript as submitted and agree to be accountable to all aspects of the work.