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Socioeconomic status, child enrichment factors, and cognitive performance among preschool-age children: Results from the Follow-Up of Growth and Development Experiences study

机译:学龄前儿童的社会经济状况,儿童富裕因素和认知能力:成长和发展经验研究的随访结果

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Lower cognitive performance is associated with poorer health and functioning throughout the lifespan and disproportionately affects children from lower socioeconomic status (SES) populations. Previous studies reporting positive associations between child home enrichment and cognitive performance generally had a limited distribution of SES. We evaluated the associations of SES and child enrichment with cognitive performance in a population with a wide range of SES, particularly whether enrichment attenuates associations with SES. Children were sampled from a case-control study of small-for-gestational-age (SGA) conducted in a public hospital serving a low SES population (final n=198) and a private hospital serving a middle-to-high SES population (final n=253). SES (maternal education and income) and perinatal factors (SGA, maternal smoking and drinking) were obtained from maternal birth interview. Five child home enrichment factors (e.g. books in home) and preschool attendance were obtained from follow-up interview at age 4.5 years. Cognitive performance was assessed with the Differential Ability Scales (DAS), a standardized psychometric test administered at follow-up. SES and enrichment scores were created by combining individual factors. Analyses were adjusted for perinatal factors. Children from the public birth hospital had a significantly lower mean DAS general cognitive ability (GCA) score than children born at the private birth hospital (adjusted mean difference -21.4, 95% CI: -24.0, -18.7); this was substantially attenuated by adjustment for individual SES, child enrichment factors, and preschool attendance (adjusted mean difference -5.1, 95% CI: -9.5, -0.7). Individual-level SES score was associated with DAS score, beyond the general SES effect associated with hospital of birth. Adjustment for preschool attendance and home enrichment score attenuated the association between individual SES score and adjusted mean DAS-GCA among children born at both of the hospitals. The effect of being in the lower compared to the middle tertile of SES score was reduced by approximately a quarter; the effect of being in the upper compared to the middle tertile of SES score was reduced by nearly half, but this comparison was possible only for children born at the private hospital. A child's individual SES was associated with cognitive performance within advantaged and disadvantaged populations. Child enrichment was associated with better cognitive performance and attenuated the SES influence. Health care providers should reinforce guidelines for home enrichment and refer children with delays to early intervention and education, particularly children from disadvantaged populations.
机译:较低的认知能力与较差的健康状况以及整个生命周期内的功能有关,并且会严重影响来自较低社会经济地位(SES)人口的儿童。先前的研究报告了儿童家庭充实与认知能力之间呈正相关的研究,一般来说,SES分布有限。我们评估了广泛范围的SES人群中SES和儿童充实与认知能力的关联,尤其是充实是否会减弱与SES的关联。儿童是在服务于低SES人口(最终n = 198)的公立医院和服务于中至高SES人口的私立医院进行的小孕龄(SGA)病例对照研究中抽样的(最终n = 253)。 SES(孕产妇教育和收入)和围产期因素(SGA,孕产妇吸烟和饮酒)来自孕产妇出生访谈。从4.5岁时的后续访谈中获得了五个儿童家庭充实因素(例如家庭书本)和学龄前出勤率。认知能力通过差异能力量表(DAS)进行评估,DAS是后续进行的标准化心理测验。通过结合各个因素来创建SES和浓缩分数。调整分析围产期因素。公立医院的孩子的DAS平均一般认知能力(GCA)得分明显低于私立医院的孩子(校正后的平均差异-21.4,95%CI:-24.0,-18.7);通过调整个体SES,儿童富集因素和学龄前出勤率(调整后的平均差异-5.1,95%CI:-9.5,-0.7),这大大减弱了。个体水平的SES评分与DAS评分相关,超出了与出生医院相关的一般SES效果。调整学前出勤率和家庭充实分数会削弱两家医院出生的孩子的个体SES分数与调整后的平均DAS-GCA之间的关联。与SES评分的中三分位数相比,处于较低水平的影响降低了大约四分之一;与SES评分的中三分位数相比,居于上位的影响降低了近一半,但这种比较仅适用于在私人医院出生的孩子。在有利和不利人群中,儿童的个体SES与认知能力有关。儿童充实与更好的认知能力有关,并减轻了SES的影响。卫生保健提供者应加强家庭致富的指导方针,并将延误的儿童送往早期干预和教育,特别是弱势群体的儿童。

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