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America Becoming: Racial Trends and Their Consequences - Volume II 12 Racial and Ethnic Trends in Children’s and Adolescents’ Behavior and Development Vonnie C.McLoyd and Betsy Lozoff Behavioral and developmental problems are major challenges for U.S. children (Committee on Psychosocial Aspects of Child and Family Health, 1993). Psychosocial and developmental problems, and their interference with normal functioning, have been termed the “new morbidity” (Haggerty et al., 1975), and many of these problems appear to have a strong connection to race and ethnicity. In this chapter, we examine the prevalence of some of these problems in terms of race and ethnicity, and we assess whether and how the connection between race and ethnicity and these problems has changed over time. Addressed also is the concept of public policies as factors contributing to changes in prevalence in the general population, to race and ethnic differences in prevalence, and to race- and ethnic-related historical trends. Our analysis focuses on two broad sets of indicators: (1) negative physical health conditions during infancy—i.e., iron deficiency, elevated lead levels, low birth weight, prenatal alcohol exposure; and (2) psychosocial problems salient during adolescence—i.e., assaultive violence and homicide, suicide, drug use. We selected these indicators because, historically, there have been striking ethnic and racial differences in their prevalence, and because their preventable nature and impact on society as well as the individual have led them to be major health concerns. The physical health indicators we examine are ones that consistently have been found to contribute to poorer school achievement and lower scores on tests of cognitive functioning. While reading this chapter, there are three points of importance to note: (1) because race and poverty are closely intertwined, it is often impossible to separate racial trends from socioeconomic disadvantage; (2)
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America Becoming: Racial Trends and Their Consequences - Volume II the short summaries in this paper are oversimplified and cannot do justice to the relevant controversies or the limitations of the available studies; and (3) we emphasize national data sets wherever possible, but nationally representative samples are not available for some important indicators. CONDITIONS DURING INFANCY THAT AFFECT BEHAVIOR AND DEVELOPMENT The lower scores on tests of cognitive functioning and poorer school achievement of many minority children have received considerable attention. Results from the Third National Health and Nutrition Examination Survey (NHANES III) show that Black and Mexican children, compared to Whites at all levels of family income, receive lower scores on subtests of an IQ scale and on reading and writing achievement tests (Figure 12–1) (Kramer et al., 1995). These test results, combined with their correlates in poor school achievement, mean that the country is losing important human capacity. Perinatal problems and poor nutrition in infancy contribute to poorer behavioral and developmental outcomes. The rapid growth of the brain in the early years, and the development of fundamental mental and motor processes, make infancy a particularly vulnerable period. Despite the plasticity of the brain, children who experience early biologic insults and stressors are at higher risk for long-lasting behavioral and developmental disturbances. Although considerations of lower test scores and poorer school achievement may acknowledge the role of health and nutrition, specific information is often not incorporated into the discussion; yet this is an issue for which there is nationally representative data, showing major racial differences in the prevalence of common early biologic risks. For some of these problems, there is also evidence that dramatic changes can occur when the country identifies a problem, makes the commitment to improve the situation, and dedicates the necessary resources. Iron Deficiency On a worldwide basis, iron deficiency is the most common single-nutrient disorder. Dietary iron deficiency develops relatively slowly, and anemia is a late manifestation. Infants are at particularly high risk because they grow so rapidly and there are limited sources of iron in the infant diet. Approximately one in five babies (0 to 2 years old) in the world has iron-deficiency anemia, and an even higher percentage have iron deficiency without anemia (deMaeyer et al., 1985; Florentino and Guirriec, 1984).
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America Becoming: Racial Trends and Their Consequences - Volume II FIGURE 12–1 Mean scaled WISC-R and WRAT-R scores for children aged 6 to 16, by income level and race/ethnicity, 1988–1991. SOURCE: Kramer et al. (1995). Reprinted by permission.
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America Becoming: Racial Trends and Their Consequences - Volume II Behavioral/Developmental Outcomes Because iron is involved in neurotransmitter function and myelin formation, there is reason to worry about ill effects on brain and behavior. Iron-deficiency anemia in infancy is consistently associated with poorer scores on measures of behavior and development (Nokes et al., 1998). Roncagliolo et al. (1998) report direct evidence that iron deficiency adversely affects brain development in the human infant. A full course of iron treatment does not appear to correct lower mental and motor test scores or behavioral differences in the majority of iron-deficient-anemic infants, despite correction of anemia (Nokes et al., 1998). At early school age (Lozoff et al., 1991), and in early adolescence (Lozoff et al., 1997), formerly iron-deficient children still test lower than peers. Thus, chronic, severe iron deficiency in infancy identifies children at risk for poorer outcome even 10 years after treatment. Racial and Ethnic Differences in Prevalence There are marked ethnic and socioeconomic differences in the prevalence of iron deficiency (with or without anemia) in U.S. infants (Ogden, 1998). Iron-deficiency anemia is observed in approximately 5 percent of poor Black and Mexican-American toddlers—twice the proportion found among poor Whites. Nonpoor Black and White infants are at considerably lower risk (1.6 percent and 0.9 percent, respectively), but iron-deficiency anemia is more common in nonpoor Mexican-American toddlers (3.4 percent). The pattern is generally similar for iron deficiency without anemia (Figure 12–2) —poor White infants are three to four times more likely to be iron deficient than nonpoor White infants, but iron deficiency remains more common among nonpoor Blacks. Mexican-American infants are at higher risk regardless of socioeconomic status; iron deficiency affects approximately 18 percent and 12 percent of poor and nonpoor Mexican American infants, respectively. There is also reason to be concerned about other immigrant groups and Alaska Natives. Racial and socioeconomic differences are thought to be largely the result of different dietary habits, although blood loss may be a factor in some groups (Petersen et al., 1996). Historical Trends There has been a marked drop in the prevalence of anemia in infants and children in the United States over the last several decades (Vazquez-Seoane et al., 1985; Yip et al., 1987). Iron-deficiency anemia used to be fairly common among poor U.S. infants (U.S. Department of Health and
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America Becoming: Racial Trends and Their Consequences - Volume II FIGURE 12–2 Iron deficiency among 1- to 2-year-old children by race and poverty status. SOURCE: Ogden, C., Centers for Disease Control and Prevention, unpublished analyses, Third National Health and Nutrition Examination Survey. Human Services, 1982); it was reported to be 20.6 percent in NHANES II (1976–1980) (Life Sciences Research Office, 1984). NHANES III (1988–1991) reports an almost 10-fold reduction among poor White infants but only 4-fold among poor Black infants (Looker, 1997). Comparisons of change over time are not straightforward, however, because information combining ethnicity and poverty is readily available only for NHANES III (Ogden, 1998). Impact of Public Policies The declining prevalence of anemia among U.S. infants is compelling testimony that national health policy can have a major impact. About 30 years ago the American Academy of Pediatrics (AAP) started recommending the use of iron-fortified formula for bottle-fed babies (AAP Committee on Nutrition, 1969). The federal government’s Women, Infants, and Children program began providing iron-fortified formula. In addition, the amount of ascorbic acid (which enhances iron absorption) was increased in the infant diet, breastfeeding was encouraged (the iron in breast milk is readily absorbed), and iron-fortified infant cereals are now readily available. Elevated Lead Levels In contrast to iron, which the body requires for normal function, there is no known role for lead. The neurotoxicity of lead, though recognized
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America Becoming: Racial Trends and Their Consequences - Volume II for centuries, has become a worldwide public health problem only relatively recently because of increasing lead levels in human blood, the result of exposures to lead-based paint and leaded gasoline, among others. Behavioral/Developmental Outcomes There is no question that high levels of lead can cause permanent neurologic damage or death. Research and controversy in the last 10 to 20 years has focused on the effects of lead exposure at lower levels (Banks et al., 1997; Pocock et al., 1994; National Research Council, 1993). Taken together, the studies find that children with increased lead burdens show a variety of cognitive and behavioral differences compared to children with lower lead burdens: slightly decreased scores on measures of intelligence, poorer school performance and achievement test scores, increased distractibility, short attention span, impulsiveness, etc. Separating the effects of lead from those of socioeconomic and family factors is challenging. However, congruent findings from studies of rodent and primate models suggest that similar behavioral processes underlie the poorer developmental outcome across species (Banks et al., 1997). Racial and Ethnic Differences in Prevalence As with iron deficiency, the most recent data (1988 to 1994) show marked differences in prevalence of elevated lead levels in young children of different ethnic and socioeconomic backgrounds (U.S. Department of Health and Human Services, 1982; Pirkle et al., 1994) (Figure 12– 3). About 12 percent of children living in poverty have elevated lead levels compared to 2 percent of children in high-income families. This income gradient is observed in all ethnic groups but most markedly among Black children. In poor Black families, 22 percent of the children have elevated lead levels. Although the proportion among Black children in middle- or high-income families is much lower (6 percent), it is still higher than that among White and Mexican-American children, regardless of family income. These racial and socioeconomic differences seem to be largely related to housing—children who live in houses built before the 1960s, and currently concentrated in older inner city areas, are at highest risk (Mahaffey et al., 1982). Historical Trends As research on developmental outcomes has accumulated, the Centers for Disease Control and Prevention has progressively lowered the level of blood lead considered to be of concern—from 60 µg/dL in the
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America Becoming: Racial Trends and Their Consequences - Volume II FIGURE 12–3 Elevated blood lead among children 1 to 5 years of age by family income, race, and Hispanic origin: United States, average annual 1988–1994. Notes: Elevated blood lead was defined as having at least 10 micrograms of lead per deciliter of blood. SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, Third National Health and Nutrition Examination Survey. 1950s to 10 µg/dL in 1991 (Centers for Disease Control and Prevention, 1991; Pirkle et al., 1994). At the same time, there has been a dramatic decline in lead levels in U.S. children, although national data are not available before NHANES II in the late 1970s. For children 1 to 4 years of age, blood-lead levels have declined even further in the last decade— from a mean of 16 µg/dL in NHANES II (Mahaffey et al., 1982) to less than 4 µg/dL in NHANES III (Pirkle et al., 1994). The decline has been observed in both Black and White children; however, Blacks were at higher risk in NHANES II and continue to be so in NHANES III.
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America Becoming: Racial Trends and Their Consequences - Volume II Impact of Public Policies The story of lead and public policy is one of both pride and shame. Despite opposition and delays from affected industries, federal regulations prohibiting lead in house paint and gasoline have had a tremendous public-health impact. The declining blood-lead levels of U.S. children provide compelling proof that public policy can protect children from harm. Low Birth Weight Low birth weight (LBW) babies, weighing =2,500 g at birth, are a heterogeneous group consisting of those born prematurely and term babies who did not grow optimally in utero. Survival of LBW babies, at lower and lower birth weights, has greatly improved with the advent of neonatal intensive care. Nonetheless, the United States has higher rates of LBW babies than many other industrial societies. Although the vast majority of LBW children have normal outcomes, as a group they have higher rates of neurodevelopmental and behavioral problems (Hack et al., 1995). A small minority has severe disability, such as mental retardation, cerebral palsy, blindness, or deafness. A larger proportion show milder problems in cognition, attention, and neuromotor functioning during the school years and continuing into adolescence. There appears to be a gradient across levels of LBW: neurocognitive differences, observed at all levels of LBW (compared to babies with birth weight >2,500 g), are greater the lower the birth weight (Breslau et al., 1996). Racial and Ethnic Differences in Prevalence LBW births are more common among Blacks than among any other ethnic group (David and Collins, 1997; Foster, 1997); and LBW is a problem for Black infants regardless of the level of education (a proxy for socioeconomic status) the mother has attained (Foster, 1997). Conversely, among Whites there is a strong relationship between maternal education and LBW, such that the less education mothers have, the greater the proportion of LBW infants (National Center for Health Statistics, 1998; Guyer et al., 1997). No such gradient relationship is observed among Hispanic, American Indian or Alaska Native, or Asian or Pacific Islander mothers. All these groups have low rates of LBW births (Figure 12–4). The relatively low rates may be misleading, however. Altered glucose metabolism and diabetes during pregnancy, which occur at increased frequency in several of these groups (Balcazar et al., 1992; Kieffer et al., 1995), may lead to higher birth weight in relatively immature infants, with increased risks for poorer health and developmental outcome.
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America Becoming: Racial Trends and Their Consequences - Volume II FIGURE 12–4 Low-birth-weight live births among mothers 20 years of age and over by mother’s education, race, and Hispanic origin: United States, 1996. Note: Low birth weight refers to an infant weighing less than 2,500 grams at birth. SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. Historical Trends The LBW rate declined during the 1970s and early 1980s but has risen 10 percent since then—from a low of 6.7 percent in 1984 to 7.4 percent in 1996 (National Center for Health Statistics, 1998). Some of the recent increase can be attributed to the rising proportion of multiple births among White mothers. Among births to Black mothers, LBW fell to the lowest rate reported since 1987, but the rate remains much higher than that among other ethnic groups. The decline is not the result of fewer very small babies because the level of babies weighing<1,500 g has remained stable among Black births since the late 1980s (about 3 percent).
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America Becoming: Racial Trends and Their Consequences - Volume II Impact of Public Policies In contrast to iron deficiency and environmental lead exposure, public policy has not been as focused or effective when it comes to LBW; yet a number of interventions have been shown to reduce LBW, including prenatal care, mother’s good nutrition with adequate weight gain, control of hypertension, avoidance of long working hours and excessive physical exertion toward the end of pregnancy, etc. (Luke et al., 1995). Intervention can also improve later outcomes for LBW babies. For example, additional stimulation for the infant, and social support for families can benefit LBW babies, especially heavier LBW children of lower socioeconomic status families (Hack et al., 1995). Public laws now mandate services for infants with identified congenital disabilities, but much less progress has been made in serving LBW infants at biological and environmental risk. Prenatal Alcohol Exposure As with lead, alcohol can be toxic. During pregnancy, the mother’s drinking can impair the physical and mental development of the fetus. Behavioral/Developmental Outcomes Fetal alcohol syndrome (FAS) is characterized by a distinctive pattern of biological effects—craniofacial changes, growth retardation, and central nervous system impairment including mental retardation and/or hyperactivity (Committee on Substance Abuse and Committee on Children with Disabilities, 1993; Institute of Medicine, 1996). Deficits in growth and development are also found in non-FAS children of nonalcoholic women who drink at moderate-to-heavy levels during pregnancy (Streissguth et al., 1996). Racial and Ethnic Differences in Prevalence As yet, there are no comprehensive national data sets for effects of alcohol on fetuses. However, relevant information on alcohol consumption is available. In the 1988 National Maternal and Infant Health Survey (Faden et al., 1997), only a small proportion of women reported heavy alcohol consumption after finding out they were pregnant, but Black women (1.2 percent) and American Indian and Alaska Native (2.2 percent) women were 3 to 4 times more likely than White (0.4 percent), Hispanic (0.3 percent), or Asian and Pacific Islander (0.7 percent) women to report consuming six or more drinks per week (Figure 12–5) (Faden et al., 1997). The incidence of FAS births is approximately 10 times higher
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America Becoming: Racial Trends and Their Consequences - Volume II FIGURE 12–5 Alcohol consumption after finding out about pregnancy: Expectant mothers in the United States, 1988. SOURCE: Faden et al. (1997). Reprinted by permission. among Blacks than Whites (Abel, 1995). Incidence figures are not available for a national sample of American Indian and Alaska Natives, but a surveillance project in four communities estimated that the rate may be 3 to 4 times higher than among Blacks and 30 to 40 times higher than among Whites (Duimstra et al., 1993). FAS is also 10 times more common among women of low socioeconomic status compared to women of middle and high socioeconomic status (Abel, 1995). The effects of alcohol on the fetus worsen with successive pregnancies so that women who are moderate-to-heavy drinkers are at increased risk of giving birth to a child affected by alcohol with each succeeding pregnancy (Jacobson et al., 1996). Historical Trends FAS was only recognized 30 years ago. Although obtaining accurate information about alcohol consumption during pregnancy is challenging, national surveys are now starting to include alcohol-consumption related questions. Data show that the proportion of women who consume alcohol during pregnancy decreased after the mid-1980s (Serdula et al., 1991). Much of the decline, however, is the result of changed habits of light drinkers; there has been little decrease in heavy drinking (Serdula et al., 1991; Hankin et al., 1993), which poses the greatest risk to the fetus. In 1995 (the most recent year for which data are available), the Centers for Disease Control found that the incidence of drinking at levels that put the fetus at risk for neurobehavioral impairment was 3.5 percent, with binge
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America Becoming: Racial Trends and Their Consequences - Volume II solved (Foster, 1997). Higher teen pregnancy rates among Blacks do not explain race differentials in LBW; although the very youngest teens have higher rates of LBW babies (Leland et al., 1995), LBW actually increases with advancing age in Black women (Geronimus, 1999). The hypothesis that the explanation is genetic has also been challenged. A recent study of West African immigrant women shows that their babies were similar in weight distribution to U.S. Whites (David and Collins, 1997). Thus, it appears that environmental and behavioral factors are adversely affecting the pregnancies of U.S.-born Black women. The contribution of altered glucose metabolism and diabetes during pregnancy to the rates of LBW among some ethnic groups is another important area of research. Prenatal Alcohol Exposure There is considerable evidence that undernutrition, hypoxia, intra-uterine growth retardation, and altered iron transport are important underlying or contributing factors to some ill effects of prenatal alcohol exposure. Determining the interconnections among these factors and others should increase understanding of the mechanisms by which alcohol affects the developing fetus. There is clearly an urgent need for effective treatment programs for pregnant women with drinking problems, with special approaches needed to reach Black and American Indian and Alaska Native women. Protecting the developing fetus from the harmful effects of alcohol should be a high national priority Behavioral and Mental Health Problems Among Adolescents As we have documented, poor children from racial minority backgrounds are more likely to start life with biologic insults and stressors that adversely affect behavior and development. We need more systematic study of whether these biologic risks increase children’s vulnerability to behavioral and developmental ill effects of other disadvantages they face in growing up, such as financial stress, poor schools, dangerous neighborhoods, family violence, maternal depression, etc. Homicide and Assaultive Violence There is some evidence that the risk factors for violence vary among different ethnic groups, but knowledge in this area needs considerable expansion. Especially needed is evidence about which childhood experiences and behaviors, as well as social, economic, and cultural factors, are most predictive of future aggression or victimization among Black, Hispanic, and American Indian and Alaska Native males. Priority also
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America Becoming: Racial Trends and Their Consequences - Volume II should be given to understanding the factors that prevent as well as buffer the effects of violence among individuals in high risk groups. Although young men are at higher risk of committing and being the victims of assaultive violence, the correlates, precipitants, and buffers of violence among young ethnic minority women also warrant systematic study. Research is also needed to determine the effectiveness of different violence prevention approaches and techniques for different ethnic groups (Hammond and Yung, 1993). Drug Use The apparent discrepancy between the relatively low self-reports of drug use by Black youth and the relatively high prevalence of drug-related problems among Black adults is among the most challenging issues beckoning empirical study. Research has identified several risk factors of adolescent drug use, but we possess far less knowledge about the link between these factors and the precursors of drug abuse during adulthood. We need to understand, for different ethnic groups, what factors determine the probability that individuals who used drugs to varying degrees during adolescence experience drug-related problems as adults. Suicide Empirical study of the factors contributing to the rise in suicide among Black males is crucial, as is the development of intervention programs based on these etiologic data. Research is needed regarding racial and ethnic group disparities in the availability, use, and effectiveness of suicide prevention programs. Future Data Needs Social class and income are highly interwoven with race and ethnicity. Consequently, more precise specification of racial and ethnic trends over time requires data that are disaggregated by social class or income within racial and ethnic groups. Rarely are national data presented in this manner. Also glaring and in need of redress is the lack of across-time nationally representative epidemiological studies of depression in adolescents from different racial and ethnic backgrounds (U.S. Department of Health and Human Services, 1997). Studies of community samples indicate that depressive mood syndromes and disorders increase dramatically in adolescence compared to childhood and that they often occur in tandem with
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America Becoming: Racial Trends and Their Consequences - Volume II other symptoms and disorders such as anxiety, conduct disorders, suicidal ideation, and drug use. Moreover, preadolescent or adolescent on-set of clinical depression appears to be a major risk factor for adult depression and other major mental disorders (Petersen et al., 1993). Our ability to address these questions will be enhanced greatly by the recently initiated National Longitudinal Study of Adolescent Health, which includes methodology to measure depressive symptoms. In addition, nationally repeated surveys need to include more measures of positive functioning in adolescents, as well as more indicators that may constitute precursors of behavioral and psychological outcomes during adolescence—e.g., parenting behavior of both mothers and fathers, neighborhood characteristics, and characteristics of peer groups. Tracking the Impact of Welfare Reform The Welfare Reform Act of 1996 stands out as the single social policy adopted in recent years with the potential to disproportionately and profoundly affect ethnic minority families and children. This law mandated large reductions in the food stamp program; decreased assistance to legal immigrants; cuts in benefits to adult welfare recipients who do not find work after two years; and a five-year lifetime limit on assistance in the form of cash aid, work slots, or noncash aid such as vouchers to poor children and families, regardless of whether parents can find employment. Exercising the vast discretion given to them under the new welfare law, many states are adopting stricter work requirements and shorter time limits for public assistance than Congress envisioned. In addition, many states will no longer increase payments to women who have additional children while receiving public assistance, on the theory that increased payments create an economic incentive for parents to have more children whom they cannot support (Pear, 1997; Super et al., 1996). The new welfare reform law voids the long-standing principle of entitlement for poor children and adults alike, such that neither the federal government nor the states, in fact, have a duty to provide assistance to the poor for any period of time. The end of entitlement is signaled most glaringly by two aspects of the policy. (1) There is no longer a federal definition of who is eligible for assistance and, therefore, no guarantee of assistance to anyone; each state can decide whom to exclude in any way it wants, as long as it does not violate the Constitution. (2) Each state will get a fixed sum of federal money each year, irrespective of whether a recession or a local calamity causes a state to run out of federal funds before the end of the year (Temporary Assistance to Needy Families [TANF] block grant). Furthermore, although waivers will be granted for some, in most cases federally supported help will end after five years,
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America Becoming: Racial Trends and Their Consequences - Volume II even if a family has done everything that was asked of it and even if it is still needy (Greenberg, 1996). In light of race and ethnic disparities in residential patterns, employment, housing, and other economic-related factors, it is supremely important to determine whether the effects of welfare reform are less positive or more adverse for minority children and families than majority families and the factors responsible for these disparities. Poor Blacks and Hispanics are more likely than poor Whites to reside in economically depressed, societally isolated, urban neighborhoods where jobs are scarce and growth in entry level jobs is unlikely, and high-quality day care and health care are less accessible—all of which are available and accessible in most suburbs and nonmetropolitan areas. Poor Blacks and Hispanics also hold jobs with higher rates of displacement and lower rates of reemployment following layoffs (Fusfeld and Bates, 1984; James, 1985; Jargowsky, 1994; Simms, 1987; Wilson, 1996). These differences in context and economic prowess would appear to put Blacks and Hispanics at a distinct disadvantage in terms of their ability to comply and cope effectively with some of the new welfare provisions such as finding employment and staying afloat following cutoffs of welfare assistance. Relevant research has not yet been completed, but it is clear that there is the potential for all of the major domains of child outcomes to be affected by welfare reform. The indicators examined in this paper are only some of the relevant markers that need to be tracked. In addition to assessing the effects on these outcomes, it is important to document the effect of welfare reform on the broader ecological context within which children develop. Individual and aggregate level data on the following indicators are of particular interest: homelessness, malnutrition, crime, infant morbidity and mortality, drug and alcohol abuse, family and community violence, child abuse and placement of children in foster care, and use of mental health services. Questions that must be answered include: Will negative indicators of family, infant, and child functioning increase shortly after the time limits take effect? Over time, will these indicators return to their previous levels as families adapt?
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America Becoming: Racial Trends and Their Consequences - Volume II Are variations in welfare programs across states related to what fortunes or misfortunes befall families and children following cutoffs? Are welfare cutoffs and the events they trigger more detrimental if they occur during the infancy and preschool years, as opposed to middle-childhood and adolescence? Under what conditions do particular sets of welfare provisions have negative effects versus positive effects on children’s development? Researchers will need to be able to identify pathways of influence and intervening variables before they can answer these questions and speak with authority in policy arenas about how welfare programs might be modified to enhance children’s development, or at least be rendered less damaging. Welfare provisions may influence children through their impact on a variety of variables, including household or family income, maternal employment, maternal education, maternal physical and psychological well-being, parenting and the home environment, and child care (Zaslow et al., 1995). The multitude of questions that need to be addressed in light of welfare reform are amenable to a variety of research methodologies ranging from large-scale surveys to small-scale ethnographic studies. Data collection options include administrative records, in-home and telephone interviews, direct child assessments, self-administered questionnaires, teacher surveys, and in-home observations. Some effects can be estimated by tracking age cohorts of children within state, across time using data from various national longitudinal studies that follow children throughout childhood and into adulthood—e.g., the National Longitudinal Survey of Youth. Others may be assessed in ongoing, more rigorous within-state experimental evaluations of the effects of welfare reform demonstrations made possible by federal waivers granted to states (Collins and Aber, 1996). Still others can be addressed by across-state comparisons. Obviously, high-quality research on these issues will require creative research designs that draw on the expertise of child developmentalists, working collaboratively with sociologists, economists, social workers, and researchers from allied disciplines. REFERENCES Abel, E. 1995 An update on incidence of FAS: FAS is not an equal opportunity birth defect. Neurotoxicolology Teratology 17:437–443.
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