The principal goal of this proposal is to delineate the pathways that lead to income-related disparities in child behavior problems, with a specific emphasis on the mediating role of maternal health. While the effect of low income on child health and development has received considerable attention, little work has been done to identify intervening variables that might be subject to targeted clinical interventions. The central hypothesis of this project is that the contribution of low income to child behavior problems is mediated in part by treatable maternal conditions. The specific objectives are to: 1) examine the contribution of maternal depressive symptoms and maternal smoking to childhood behavior problems and 2) determine whether the effects of persistent low income on child behavior are attenuated after adjustment for the duration and intensity of childhood exposure to maternal depressive symptoms and smoking. If the hypotheses are supported, the findings will directly inform existing health (e.g., Medicaid) and social programs (e.g., early intervention) that target children but have much more restricted eligibility and services for parents. The project will use three nationally representative datasets, the Panel Study of Income Dynamics-Child Development Supplement, the National Longitudinal Survey of Youth, and the Infant Health and Development Program. These datasets offer the unique opportunity to delineate relationships combining longitudinal income, maternal health, and child outcomes. The challenge and the major strength of this research agenda is its integration of a social science perspective on poverty with a clinically informed analysis of health data. Robert Kahn, M.D., M.P.H., who completed his NRSA Fellowship in Primary Care Research at Children's Hospital, Boston and an M.P.H. at Harvard School of Public Health, recently joined the faculty at Children's Hospital Medical Center because of the departmental commitment to his development as an Independent investigator. This commitment has included the initial time and resources necessary for an inter-disciplinary approach to the study of poverty, maternal morbidity, and child outcomes. John Kiely, Ph.D., the project mentor, offers extensive content and methodologic expertise in modeling child outcomes using national datasets, has had prior NIH funding, and has mentored other young investigators. The environment will support a didactic program that includes relevant courses on poverty, biostatistical methods, and research ethics, as well as interaction with other independent investigators in the Division.
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