Integrating Health Care Strategies to Prevent Poverty-Related Disparities in Development and Growth: Addressing Core Outcomes of Early Childhood.
Integrating Health Care Strategies to Prevent Poverty-Related Disparities in Development and Growth: Addressing Core Outcomes of Early Childhood.
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DOI：
10.1016/j.acap.2021.04.005
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发表时间：
2021-11
影响因子：
3.1
通讯作者：
Mendelsohn AL
中科院分区：
文献类型：
--
作者：
Gross RS;Messito MJ;Klass P;Canfield CF;Yin HS;Morris PA;Shaw DS;Dreyer BP;Mendelsohn AL
与智力相关的差异出现在生命早期的认知，语言和社会情感发展，以及生长，特别是肥胖，并在整个生命过程中产生长期影响。必须制定有效的战略，促进怀孕和初为人父母期间的健康行为，以缩小差距。儿科初级保健环境中的初级预防干预措施提供了普遍可及性、高参与度和低成本的人群水平影响。虽然许多贫穷或低收入家庭将受益于与发展和增长有关的预防性服务，但大多数成功的干预措施往往只侧重于其中一个领域。在这份手稿中，我们认为，有可能同时有效地解决发展和增长问题。特别是，目前的理论模型表明，贫困可能对亲子早期关系健康造成障碍的机制是一致的（即，养育实践、创造结构和亲子关系质量），构成了这两个领域的最终共同途径。基于这些模型和相关的经验数据，我们提出了一个基于力量的，全儿童的方法，通过积极的养育目标共同的前因，并防止发展和增长的差距，我们相信这种方法有可能改变政策和实践。实现这些目标将需要新的支付系统，使医疗保健中的初级预防规模可行，研究资金，以评估疗效/有效性和告知实施，以及幼儿利益相关者之间的合作，包括跨专业的临床医生，跨学科的科学家和政策制定者。
Poverty-related disparities appear early in life in cognitive, language, and social-emotional development, and in growth, especially obesity, and have long-term consequences across the life course. It is essential to develop effective strategies to promote healthy behaviors in pregnancy and the early years of parenthood that can mitigate disparities. Primary preventive interventions within the pediatric primary care setting offer universal access, high engagement, and population-level impact at low cost. While many families in poverty or with low income would benefit from preventive services related to both development and growth, most successful interventions have tended to focus on only one of these domains. In this manuscript, we suggest that it may be possible to address both development and growth simultaneously and effectively. In particular, current theoretical models suggest alignment in mechanisms by which poverty can create barriers to parent-child early relational health (i.e., parenting practices, creating structure, and parent-child relationship quality), constituting a final common pathway for both domains. Based on these models and related empirical data, we propose a strength-based, whole child approach to target common antecedents through positive parenting and prevent disparities in both development and growth; we believe this approach has the potential to transform policy and practice. Achieving these goals will require new payment systems that make scaling of primary prevention in health care feasible, research funding to assess efficacy/effectiveness and inform implementation, and collaboration among early childhood stakeholders, including clinicians across specialties, scientists across academic disciplines, and policy makers.