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Published on: January 12, 2018
Poverty, Toxic Stress, and Education in Children Born Preterm
1Michelle M. Kelly, PhD, CRNP, is Assistant Professor, M. Louise Fitzpatrick College of Nursing, Villanova University, Pennsylvania. Kati Li, PhD, is Research Analyst, Office of Planning & Institutional Research, Villanova University, Pennsylvania.
Insights
Preterm birth combined with poverty and toxic stress significantly increases risks for developmental and learning disabilities in children. Healthcare providers should address these combined vulnerabilities for better child outcomes.
Area of Science:
- Child development
- Public health
- Neuroscience
Background:
- Preterm birth is a global epidemic with long-term health consequences.
- Toxic stress from adverse childhood experiences alters brain development and future health.
- The eco-bio-developmental model links poverty and preterm birth to adverse outcomes.
Purpose of the Study:
- To apply the eco-bio-developmental model to analyze the association between poverty, toxic stress, and prematurity.
- To evaluate the impact of these factors on neurodevelopmental and educational outcomes in children.
Main Methods:
- Analysis of cross-sectional data from the 2016 National Survey of Children's Health (n=15,010).
- Inclusion of children aged 6-11 years.
- Multivariate analysis using logistic regression and interaction effects to explore relationships between prematurity, toxic stress, and poverty.
Main Results:
- Children born preterm showed higher rates of toxic stress, poverty, developmental delay, learning disabilities, intellectual disability, speech/language disorders, ADD/ADHD, autism, and special education needs.
- The combination of poverty, toxic stress, and preterm birth significantly elevated the risk for these conditions.
- Toxic stress independently increased the incidence of ADD/ADHD and autism.
Conclusions:
- The study supports the eco-bio-developmental model's findings on the negative impact of poverty and toxic stress on preterm children.
- Healthcare providers are urged to address the combined risks of prematurity, poverty, and toxic stress.
Background:
Preterm birth, defined as birth before the completion of 37 weeks of gestation, is a multifactorial global epidemic with psychosocial, economic, and physical ramifications affecting the child, family, and community at large. Toxic stress-the results of exposure to adverse childhood experiences-results in changes to brain structure and function that negatively affects future health.
Objectives:
The aim of this study was to apply the eco-bio-developmental (EBD) model of poverty and preterm birth to the cross-sectional data of the 2016 National Survey of Children's Health to evaluate the associations between poverty, toxic stress, and prematurity on neurodevelopmental and educational outcomes.
Methods:
A subset of data representing children ages 6-11 years old (n = 15,010) from the 2016 National Survey of Children's Health was used for multivariate analysis of demographic variables and neurodevelopmental and educational outcome variables. Pearson's chi-square, logistic regression, and interaction effects explored the relationships between prematurity, toxic stress, and poverty.
Results:
Children in this sample born preterm had a higher incidence of toxic stress, poverty, developmental delay, learning disability, intellectual disability, speech/language disorders, attention-deficit disorder (ADD)/attention-deficit/hyperactivity disorder (ADHD), autism, and special education/early intervention plans. The combination of poverty, toxic stress, and preterm birth significantly increased the risk of these conditions. After accounting for gender, insurance coverage, race, and parental education, children in the sample born preterm were more likely to experience developmental delay, intellectual disability, speech/language disorder, learning disability, and ADD/ADHD. Toxic stress increased the incidence of ADD/ADHD and autism in both the preterm and full-term samples.
Discussion:
The negative effect of poverty and toxic stress on children born preterm, as depicted by the eco-bio-developmental model, is supported by this analysis. Healthcare providers are encouraged to address the tripartite vulnerability resulting from prematurity, poverty, and toxic stress.
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