Identification of modifiable social and behavioral factors associated with childhood cognitive performance

1. Moderate increases in positive exposures were associated with improved cognitive performance in children.

2. Black children experienced fewer cognitively beneficial exposures than other racial groups.

Evidence Rating Level: 2 (Good)

Racial disparities in all aspects of healthcare are at least partially consequences of inequitable social environments. Identifying and modifying these risk factors associated with racial disparities can serve to reduce or prevent these disparities in long-term health outcomes. This longitudinal pregnancy cohort study sought to identify these modifiable risk factors associated with childhood cognitive performance. A total of 1,503 mother-child dyads were enrolled in the University of Tennessee Health Science Center-Conditions Affecting Neurodevelopment and Learning in Early Life study between December 1, 2006 and July 31, 2011. Women were recruited between 16 and 28 weeks’ gestation from four hospitals in one Tennessee county (M [SD] age = 26.0 [5.6] years, 64.1% Black). These individuals were evaluated annually until children reached four to six years of age. Of these dyads, 1,055 were used in subsequent analyses with 155 prenatal, perinatal, and postnatal exposures, involving socioeconomic position, family structure, maternal mental health, nutrition, parenting behaviours, and other factors. Approximately 50.4% of the children were female and 59.0% of the women had a high school education or lower. Following the least absolute shrinkage and selection operator regression analysis, 24 factors were retained. Child cognitive performance, as measured by the Stanford-Binet Intelligence Scales, Fifth Edition (SB-5), was associated with parental education and breastfeeding. For every one standard deviation increase in exposure, positive associations were discovered with cognitive growth fostering from dyad interactions (β = 1.12, 95% CI 0.24 to 2.0) and maternal reading ability (β = 1.42, 95% CI 0.16 to 2.68). A negative association was found between cognitive performance and parenting stress (β = -1.04, 95% CI -1.86 to -0.21). Moderate increases in the positive exposures were associated with improvement in estimated cognitive performance using marginal means (0.5% of 1 SD). Black children were exposed to fewer beneficial cognitive performance measures than other racial groups, though no significant racial disparities were noted in cognitive performance. Overall, this study suggests that individuals can capitalize on positive exposures through increasing their frequency, which seems to improve cognitive development in early childhood.

Click to read the study in JAMA Pediatrics

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