TY - JOUR
T1 - Effects of responsive caregiving and learning opportunities during pre-school ages on the association of early adversities and adolescent human capital
T2 - an analysis of birth cohorts in two middle-income countries
AU - 1993 Pelotas and Birth to Twenty Plus investigators
AU - Trude, Angela C.B.
AU - Richter, Linda M.
AU - Behrman, Jere R.
AU - Stein, Aryeh D.
AU - Menezes, Ana M.B.
AU - Black, Maureen M.
N1 - Funding Information:
The Bill & Melinda Gates Foundation funded the study (OPP1148933). Birth to Twenty Plus has been principally funded by the Wellcome Trust, the South African Medical Research Council, the South African Human Sciences Research Council, and the University of the Witwatersrand. The 1993 Pelotas Birth Cohort Study was funded by the Postgraduate Program in Epidemiology at Universidade Federal de Pelotas, with the collaboration of the Brazilian Public Health Association, and in part by the Wellcome Trust, the EU, National Support Program for Centers of Excellence, Brazil, the Brazilian National Research Council, the Foundation for Research Support of the State of Rio Grande do Sul, and the Brazilian Ministry of Health. ACBT and MMB received funding from the US National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK107761). JRB received funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R21 HD097576). ADS received funding from the Gates Foundation (OPP 1164115). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the funders. We acknowledge the invaluable assistance of Cesar Victora, Helen Gonçalves, Joseph Murray, and Luciana Anselmi at the Federal University of Pelotas (Pelotas, Brazil). We are grateful to all the families who participated in the birth cohort studies. We thank the research teams at the participating cohorts for their hard work and support.
Funding Information:
The Bill & Melinda Gates Foundation funded the study (OPP1148933). Birth to Twenty Plus has been principally funded by the Wellcome Trust, the South African Medical Research Council, the South African Human Sciences Research Council, and the University of the Witwatersrand. The 1993 Pelotas Birth Cohort Study was funded by the Postgraduate Program in Epidemiology at Universidade Federal de Pelotas, with the collaboration of the Brazilian Public Health Association, and in part by the Wellcome Trust, the EU, National Support Program for Centers of Excellence, Brazil, the Brazilian National Research Council, the Foundation for Research Support of the State of Rio Grande do Sul, and the Brazilian Ministry of Health. ACBT and MMB received funding from the US National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK107761). JRB received funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R21 HD097576). ADS received funding from the Gates Foundation (OPP 1164115). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the funders. We acknowledge the invaluable assistance of Cesar Victora, Helen Gonçalves, Joseph Murray, and Luciana Anselmi at the Federal University of Pelotas (Pelotas, Brazil). We are grateful to all the families who participated in the birth cohort studies. We thank the research teams at the participating cohorts for their hard work and support.
Publisher Copyright:
© 2021 Elsevier Ltd
PY - 2021/1
Y1 - 2021/1
N2 - Background: Millions of children globally are at risk of not reaching their developmental potential because of early adversities. We hypothesised that responsive caregiving and learning opportunities, components of nurturing care, at pre-school ages might mitigate the effects of adversities. Methods: We analysed longitudinal birth cohort data from Brazil (1993 Pelotas Birth Cohort, n=632) and South Africa (Birth to Twenty Plus [Bt20+] Birth Cohort, n=1130) to assess whether responsive caregiving and learning opportunities at pre-school ages (2–4 years) modified associations between cumulative early adversities and adolescent human capital. The cumulative adversities score (range 0–9) included household wealth and crowding; mothers' schooling, height, age, and mental health; and children's birthweight, gestational age, and length at age 12 months. We extracted data on responsive caregiving and learning opportunities from the Early Childhood Home Observation for Measurement of the Environment inventory, assessed at age 4 years (1993 Pelotas cohort) and 2 years (Bt20+ cohort). We examined three human capital indicators: intelligence quotient (IQ) assessed at age 18 years (1993 Pelotas cohort) and 16 years (Bt20+ cohort); psychosocial adjustment assessed at age 15 years and 14 years, respectively; and height assessed at age 18 years and 16 years, respectively. We used linear models with interaction terms between cumulative adversities, and responsive caregiving and learning opportunities, to predict adolescent human capital. Findings: For each additional Z score of total cumulative adversity, adolescent IQ decreased by 5·89 (95% CI −7·29 to −4·50) points in the 1993 Pelotas cohort (p<0·0001) and 2·69 (–4·52 to −0·86) points in the Bt20+ cohort (p=0·0039). After adjusting for total cumulative adversities, adolescent IQ points increased by 5·47 (95% CI 4·20 to 6·74) with each additional Z score of learning opportunities and by 2·26 (0·93 to 3·59) with each additional Z score of responsive caregiving in the 1993 Pelotas cohort, but not in the Bt20+ cohort (0·86 [–0·12 to 1·83] and 0·65 [–0·32 to 1·61], respectively). Associations between early adversities and IQ were modified by learning opportunities in the 1993 Pelotas cohort (beta coefficient for interaction 1·74, 95% CI 0·43 to 3·04; p=0·0092) and by responsive caregiving in the Bt20+ cohort (2·24, 0·94 to 3·54; p=0·0075). High nurturing environment attenuated the negative effects of early cumulative adversities on IQ. Interpretation: Early nurturing home environments protect young children against effects of early adversities on adolescent IQ, with long-term positive associations on adolescent cognition in two middle-income countries. Funding: Bill & Melinda Gates Foundation.
AB - Background: Millions of children globally are at risk of not reaching their developmental potential because of early adversities. We hypothesised that responsive caregiving and learning opportunities, components of nurturing care, at pre-school ages might mitigate the effects of adversities. Methods: We analysed longitudinal birth cohort data from Brazil (1993 Pelotas Birth Cohort, n=632) and South Africa (Birth to Twenty Plus [Bt20+] Birth Cohort, n=1130) to assess whether responsive caregiving and learning opportunities at pre-school ages (2–4 years) modified associations between cumulative early adversities and adolescent human capital. The cumulative adversities score (range 0–9) included household wealth and crowding; mothers' schooling, height, age, and mental health; and children's birthweight, gestational age, and length at age 12 months. We extracted data on responsive caregiving and learning opportunities from the Early Childhood Home Observation for Measurement of the Environment inventory, assessed at age 4 years (1993 Pelotas cohort) and 2 years (Bt20+ cohort). We examined three human capital indicators: intelligence quotient (IQ) assessed at age 18 years (1993 Pelotas cohort) and 16 years (Bt20+ cohort); psychosocial adjustment assessed at age 15 years and 14 years, respectively; and height assessed at age 18 years and 16 years, respectively. We used linear models with interaction terms between cumulative adversities, and responsive caregiving and learning opportunities, to predict adolescent human capital. Findings: For each additional Z score of total cumulative adversity, adolescent IQ decreased by 5·89 (95% CI −7·29 to −4·50) points in the 1993 Pelotas cohort (p<0·0001) and 2·69 (–4·52 to −0·86) points in the Bt20+ cohort (p=0·0039). After adjusting for total cumulative adversities, adolescent IQ points increased by 5·47 (95% CI 4·20 to 6·74) with each additional Z score of learning opportunities and by 2·26 (0·93 to 3·59) with each additional Z score of responsive caregiving in the 1993 Pelotas cohort, but not in the Bt20+ cohort (0·86 [–0·12 to 1·83] and 0·65 [–0·32 to 1·61], respectively). Associations between early adversities and IQ were modified by learning opportunities in the 1993 Pelotas cohort (beta coefficient for interaction 1·74, 95% CI 0·43 to 3·04; p=0·0092) and by responsive caregiving in the Bt20+ cohort (2·24, 0·94 to 3·54; p=0·0075). High nurturing environment attenuated the negative effects of early cumulative adversities on IQ. Interpretation: Early nurturing home environments protect young children against effects of early adversities on adolescent IQ, with long-term positive associations on adolescent cognition in two middle-income countries. Funding: Bill & Melinda Gates Foundation.
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U2 - 10.1016/S2352-4642(20)30309-6
DO - 10.1016/S2352-4642(20)30309-6
M3 - Article
C2 - 33340466
AN - SCOPUS:85097738586
SN - 2352-4642
VL - 5
SP - 37
EP - 46
JO - The Lancet Child and Adolescent Health
JF - The Lancet Child and Adolescent Health
IS - 1
ER -