Subject: Studies in the News 06-44 (October 16, 2006)


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Studies in the News for
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Children and Families Commission


Contents This Week

Introductory Material DEMOGRAPHY
   Review of Child Well-Being Index
EDUCATION
   Musical training and brain development
   Early intervention system for learning disabilities
   Early childhood and rural children
   Language barriers to early education access
   Head Start programs, participants and staff
   How babies learn to talk
   Language barriers to school/parent communication
   Latest issue of Preschool Matters
HEALTH
   Physical activity and nutrition resources
   Children's health in San Mateo county
   Study urges cutback in soda
   Effectiveness of vaccines and PCB exposure
   Breastfeeding has little impact on intelligence
   Children's mental health
   Biochemical drive possible cause for obesity
   Minority children more likely to be uninsured
   America's uninsured children
HUMAN SERVICES
   Improving family, friend and neighbor child care
   Effects of child-caregiver ratios in child care
   Early childhood home visiting
STUDIES TO COME
   Quality of life and low birth weight
   Morbid obesity and low IQ in toddlers
   Factors influencing childhood obesity
   Parents attitudes about vaccine safety
Introduction to Studies in the News

Studies in the News: Children and Family Supplement is a service provided to the First 5 California by the California State Library. The service features weekly lists of current articles focusing on Children and Family policy. Prior lists can be viewed from the California State Library's Web site at www.library.ca.gov/CRB/SITN/.

How to Obtain Materials Listed in SITN:

  • When available on the Internet, the URL for the full-text of each item is provided.

  • California State Employees may contact the State Information & Reference Center (916-654-0206; cslsirc@library.ca.gov) with the SITN issue number and the item number [S#].

  • All other interested individuals should contact their local library - the items may be available there, or may be borrowed by your local library on your behalf.

The following studies are currently on hand:

DEMOGRAPHY

CHILDREN

Review of the Child Well-Being Index. By the Brookings Center on Children and Families and the Foundation for Child Development. (The Foundation, New York, New York) May 10, 2006.

["The Brookings Institution’s Center on Children and Families hosted the conference, 'Review of the Child Well-Being Index', to discuss several issues related to the construction and use of the Foundation for Childe Development's (FCD) Child Well-Being Index (CWI) [#61518]. The CWI is a national measure of how American children have fared since 1975. FCD has released the CWI annually since 2004. A summary of the conference, a transcript of the entire discussion, and four background papers are available below." The Learning Curve, Foundation for Child Development (August 31, 2006).]

Conference Summary: 9 p.
http://www.fcd-us.org/ourwork/conferencesummary.html

Conference Transcript: 312 p.
http://www.fcd-us.org/PDFs/ScholarsConferenceTranscript.pdf

Measuring Social Disparities: 40 p.
http://www.fcd-us.org/PDFs/HernandezPaper.pdf

Developing State Indices of Child Well-Being: 13 p.
http://www.fcd-us.org/PDFs/OHarePaper.pdf

Are All Indicators Created Equal? 21 p.
http://www.fcd-us.org/PDFs/ZillPaper.pdf

Does the CWI Measure Representative Domains of Child Well-Being? 5 p.
http://www.fcd-us.org/PDFs/BrownPaper.pdf

[Request #S64401]

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EDUCATION

ARTS IN EDUCATION

"One Year of Musical Training Affects Development of Auditory Cortical-Evoked Fields in Young Children." By Takako Fujioka, University of Toronto, Canada, and others. IN: Brain, vol. 129, no. 10 (October 2006) pp. 2593-2608.

Full Text at: brain.oxfordjournals.org/cgi/reprint/129/10/2593

["Researchers have found the first evidence that young children who take music lessons show different brain development and improved memory over the course of a year compared to children who do not receive musical training. The findings... show that not only do the brains of musically-trained children respond to music in a different way than those of untrained children, but that training also improves their memory. After one year the musically trained children performed better in a memory test that correlates with general intelligence skills such as literacy, verbal memory, visiospatial processing, mathematics and IQ. The Canadian-based researchers reached these conclusions after measuring changes in brain responses to sounds in children aged between four and six. Over the period of a year they took four measurements in two groups of children - those taking Suzuki music lessons and those taking no musical training outside school - and found developmental changes over periods as short as four months." Science Daily (September 20, 2006).]

[Request #S64402]

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DISABILITIES

Recognition and Response: An Early Intervening System for Young Children At-Risk for Learning Disabilities. By Mary Ruth Coleman and others. (FPG Child Development Institute, The University of North Carolina, Chapel Hill, North Carolina) May 1, 2006. 60 p.

[This paper "discusses the challenges for early educators and parents in addressing the learning difficulties of pre-school age children. It also advocates for a new systemic approach that can help early educators and parents ensure early school success for all children, including those at risk for learning difficulties.... The paper explains that this new model, which includes such components as universal screening and progress monitoring, facilitates a seamless transition from Pre-K to kindergarten and emphasizes the importance of decision-making based on carefully targeted student data." ExchangeEveryDay (September 6, 2006).]

Executive Summary: 8 p.
http://www.fpg.unc.edu/~randr/pdfs/200607_RecResp_ExecSum.pdf

Full Report: 60 p.
http://www.fpg.unc.edu/~randr/pdfs/2006Synthesis_RandR_ES.pdf

[Request #S64403]

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EARLY CHILDHOOD EDUCATION

Rural Disparities in Baseline Data of the Early Childhood Longitudinal Study: A Chartbook. By Cathy Grace and others, National Center for Rural Early Childhood Learning Initiatives, Mississippi State University. (Mississippi State, Mississippi) 2006. 28 p.

Full Text at:

[This report helps fill a gap in information available on the status of young children living in rural areas. This report, from the National Center for Rural Early Childhood Initiatives at Mississippi State University and Child Trends, discusses differences in demographics, family life, health and physical development, social-emotional development, cognitive development, child care, and kindergarten experience between rural and urban children. The data come from the Early Childhood Longitudinal Study, kindergarten and birth cohort studies and are presented by racial/ethnic and rural/non-rural subgroups." The Child Indicator (Summer 2006).]

Front Matter: List of Tables, List of Figures, Introduction, Discussion: 28 p.
http://www.ruralec.msstate.edu/reports/ecls-frontmatter.pdf

Tables: Rural Disparities in the ELCS-K Baseline Data: 51 p.
http://www.ruralec.msstate.edu/reports/ecls-tables-k.pdf

Rural Disparities in the ECLS-B Baseline Data: 69 p.
http://www.ruralec.msstate.edu/reports/ecls-tables-b.pdf

[Request #S64404]

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Child Care and Early Childhood Education: More Information Sharing and Program Review by HHS Could Enhance Access for Families with Limited English Proficiency. By the U.S. General Accountability Office. GAO-06-807 (The Office, Washington, DC) August 2006.

["HHS’s Child Care Bureau (CCB) did not have information on the total enrollment in CCDF programs of children whose parents had limited English proficiency, but data collected by its Office of Head Start in 2003 showed that about 13 percent of parents whose children were in Head Start reported having limited English proficiency. The most recent (1998) national survey data showed that children of parents with limited English proficiency were less likely than other children to receive financial assistance for child care from a social service or welfare agency or to be in Head Start, after controlling for selected characteristics.... The majority of state and local agencies and providers that we interviewed on our site visits took some steps to assist parents with limited English proficiency, but officials reported challenges in serving these parents."]

Highlights: 1 p.
http://www.gao.gov/highlights/d06807high.pdf

Report: 76 p.
http://www.gao.gov/new.items/d06807.pdf

Executive Summaries in Spanish, Chinese, Vietnamese and Korean:
http://www.gao.gov/translations/childcare.html

[Request #S64405]

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HEAD START

More than Meets the Eye: Head Start Programs, Participants, Families, and Staff in 2005. By Katie Hamm. Policy Brief No. 8 (Center for Law and Social Policy, Washington, DC) August 2006. 8 p.

Full Text at: www.clasp.org/publications/hs_brief8.pdf

["This policy brief examines the latest data from the Program Information Reports (PIR) that all Head Start programs must submit to the U.S. Department of Health and Human Services. In 2005, Head Start served fewer children than in previous years. At the same time, PIR data show that Head Start is increasingly a provider of last resort for low-income families. Despite a decrease in the number of families served, there was an increase in the number of families accessing an array of services through Head Start, including services for substance abuse, child abuse or neglect, mental health, and English as a Second Language courses. As in previous years, teacher education levels increased, but salaries remained stagnant." Early Education in the News (September 5, 2006).]

[Request #S64406]

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INFANTS AND CHILDREN

"Infant Speech Perception Activates Broca’s Area: A Developmental Magnetoencephalography Study." By Toshiaki Imada, University of Washington, and others. IN: NeuroReport, vol. 17, no. 10 (July 2006) pp. 957-962.

Full Text at: ilabs.washington.edu/kuhl/pdf/Kuhl_Baby_MEG_study_2006.pdf

["It is one of the great wonders of humanity: A baby hears parents and others talking and learns to speak. Now, with parents volunteering their infants, researchers at the University of Washington are learning just what happens in the babies' brain to make that miracle unfold.... First, trillions of new nerve connections form in the part of the brain called Wernicke's Area, which is responsible for speech recognition. A few months later, neurons come alive in Broca's Area, the part responsible for speech.... The research has revealed that there can be enormous variation in how quickly the young brains respond. Researchers hope that by discovering how babies normally acquire language, they'll learn how to intervene if something is wrong and the process is not going properly. This could lead to better interventions to prevent autism, dyslexia and other problems." NBC Nightly News (September 28, 2006).]

[Request #S64407]

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PARENTS

School and Parent Interaction by Household Language and Poverty Status: 2002–03. By the National Center for Education Statistics. NCES 2006–086. Issue Brief. (U.S. Department of Education, Washington, DC) September 2006. 4 p.

Full Text at: nces.ed.gov/pubs2006/2006086.pdf

["Language minority parents may face a number of challenges when trying to communicate or become involved with their child’s school. This Issue Brief describes school-to-home communication practices and opportunities for parent involvement at school as reported by parents of U.S. school-age students from primarily English- and primarily Spanish-speaking households during the 2002–03 school year.... Among the findings: A greater percentage of students in English-speaking households than in Spanish-speaking households had parents who reported receiving personal notes or e-mails about the student; receiving newsletters, memos, or notices addressed to all parents; opportunities to attend general meetings; opportunities to attend school events; and chances to volunteer. Differences were still apparent after taking poverty status into account."]

[Request #S64408]

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PRESCHOOL

Preschool Matters [Entire Issue.] By the National Institute for Early Education Research. Vol. 4, No. 5 (The Institute, New Brunswick, New Jersey) August/September 2006. 12 p.

Full Text at: nieer.org/resources/printnewsletter/AugSep2006.pdf

["Preschool Matters takes a look at the alarming picture of early education need contained in a recent report from the National Center for Rural Early Childhood Learning Initiatives at Mississippi State University and the challenges associated with providing early childhood education in rural areas. Also in the new issue of Preschool Matters: Illinois Takes a Pre-K Teacher Head Count; Pre-K One Year After Hurricane Katrina; Q & A on PK-3 with Noted Author Gene Maeroff; New Momentum for Pre-K in Washington State; Discoveries: Executive Function in Preschoolers; Recommended Reading." NIEER Online Newsletter (September 18, 2006).]

[Request #S64409]

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HEALTH

CHILDREN

Physical Activity and Nutrition in Child Care Settings: A Web Directory for Providers. (National Child Care Information Center, Administration for Children and Families, U.S. Department of Health and Human Services, Washington, DC) 2006. Interactive website.

Full Text at: fitsource.nccic.acf.hhs.gov/fitsource/

[This web directory "links child care and after school providers to a wide variety of physical activity and nutrition resources. Housed within the website of the National Child Care Information Center (NCCIC), 'Fit Source' offers links to activities, lesson plans, healthy recipes, information for parents, and many other downloadable tools that can be used to incorporate physical activity and nutrition into child care and after school programs. Resources are organized by age: infant/toddler, preschool and school-age." Natural Resources (October 4, 2006).]

[Request #S64410]

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Evaluation of the San Mateo County Children’s Health Initiative: Third Annual Report. By Embry Howell, Urban Institute, and others. (The Urban Institute, Washington, DC) September 2006. 76 p.

Full Text at: www.urban.org/UploadedPDF/411365_san_mateo_health.pdf

["This report, the third in a series of five annual reports from the Evaluation of the San Mateo County Children's Health Initiative (CHI), provides an overview of the Initiative as well as a detailed look at particular aspects of the program and access to specific services. During 2005 the initiative took on several new challenges, such as an increased focus on improving retention in public programs, increasing use of preventive care, and improving access to dental and mental health care. This annual report provides some new data on several of these and other issues that are important to the continued development of the initiative."]

[Request #S64411]

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"Intake of Sugar-Sweetened Beverages and Weight Gain: A Systematic Review. By Vasanti S. Malik and others. IN: The American Journal of Clinical Nutrition, vol. 84, no. 2 (August 2006) pp. 274-288.

Full Text at: www.ajcn.org/cgi/reprint/84/2/274

["The role of soda in America's bulging waistline has been hotly debated, but a new analysis says that it has been an increasing source of calories for children and adults, a trend that likely has led to weight gain and obesity. While providing little nutrition, soda most likely has increased the risk of diabetes, fractures and cavities, according to a review article in the American Journal of Clinical Nutrition. The typical 12-ounce soda has 150 calories and the equivalent of 10 teaspoons of sugar, mostly in the form of high-fructose corn syrup, the article said. Drinking one soda a day can lead to a one-year weight gain of 15 pounds. The review also questions the role of high-fructose corn syrup, which is used to sweeten soft drinks in the United States, while sucrose is used in Europe. It may increase the risk for diabetes. Although the two sweeteners contain the same amount of calories, chemical differences have led some to theorize that fructose may cause greater weight gain and insulin resistance by elevating triglycerides." Milwaukee Journal Sentinel (August 9, 2006).]

[Request #S64412]

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"Reduced Antibody Responses to Vaccinations in Children Exposed to Polychlorinated Biphenyls." By Carsten Heilmann and others. IN: PLoS Medicine, vol. 3, no. 8 (August 2006) 8 p.

Full Text at: medicine.plosjournals.org/archive/1549-1676/3/8/pdf/10.1371_journal.pmed.0030311-L.pdf

["New epidemiological evidence suggests that exposure to environmental pollutants may have an adverse impact on immune responses to childhood vaccinations.... The findings showed an association between increased PCB contamination and lowered antibody response to the vaccines.... 'Our study raises concern that exposure to PCB and similar compounds may make childhood vaccinations less efficient,' said Philippe Grandjean , adjunct professor at Harvard School of Public Health and co-author of the paper. Exposed children may also be more susceptible to infections in general, he said." Harvard School of Public Health (August 22, 2006) 1.]

[Request #S64413]

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INFANTS & CHILDREN

"Effect of Breast Feeding on Intelligence in Children: Prospective Study, Sibling Pairs Analysis, and Meta-Analysis." By Geoff Der and others. IN: British Medical Journal, Online First (October 4, 2006) 6 p.

Full Text at: bmj.bmjjournals.com/cgi/rapidpdf/bmj.38978.699583.55v1

["The link between breastfeeding and children’s intelligence has been studied but remained unclear. Now researchers from the Medical Research Council Social and Public Health Sciences Unit in Glasgow found that when considered in isolation, breastfeeding did appear to have a beneficial effect on a child’s intelligence. However, once other factors were considered – including maternal intelligence, home environment and socio-economic status - breastfeeding made less than half a point difference to children’s intelligence scores.... The authors conclude that whilst breastfeeding does not enhance child intelligence, it remains important for the healthy growth and development of infants and has many advantages for both mother and child." Toronto Daily News (October 4, 2006) 1.]

[Request #S64414]

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MENTAL HEALTH

Children's Mental Health: States Reach Out to the Youngest Patients. By Jennifer Stedron. State Health Notes, vol. 27, no. 473 (August 7, 2006) pp. 1-3.

Full Text at: www.ncsl.org/print/health/shn/id473.pdf

["Research suggests that early concerns, such as withdrawal or sleeplessness, can be predictors of later mental health problems. And early intervention for those concerns, such as parent-infant therapy, may ward off later depression or developmental delays -- which can improve school readiness and academic success, in addition to overall child (and later, adult) well being."]

[Request #S64415]

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OBESITY

"Childhood Obesity: Behavioral Abberation or Biochemical Drive?" By Robert H. Lustig. IN: Nature Clinical Practice Endocrinology and Metabolism, vol. 2, no. 8 (August 2006) pp. 447-458.

["The obesity epidemic is caused by a 'poisoned' food supply that is altering people's biochemistry and driving them to eat more and move less, according to a hypothesis proposed by a UCSF doctor who culled results from thousands of studies on obesity. Sugar in large quantities drives up insulin secretion. This insulin floods the brain, and in particular the hypothalamus, which regulates energy use in the body. As a result, leptin, a hormone that tells the brain when the body needs more or less energy, can't get its signal to the hypothalamus because the insulin is blocking the way. The result is that the body is thrown into starvation mode - the brain thinks it isn't getting enough energy, so it needs more calories and it needs to save energy." San Francisco Chronicle (August 12, 2006) 1.]

[Request #S64416]

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UNINSURED

America’s Uninsured Children: Minority Children at Greater Risk. By Families USA. (Campaign for Children’s Health Care, Washington, DC) September 2006. 4 p.

Full Text at: www.childrenshealthcampaign.org/assets/pdf/Uninsured-Minority-Kids-at-Risk.pdf

["Going without health insurance can have devastating consequences for children. While children of all races and ethnicities are affected by lack of health insurance coverage, minority children are most at risk. Of the 9,069,000 uninsured children in this country, more than 60 percent are racial or ethnic minorities."]

[Request #S64417]

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No Shelter From the Storm: America’s Uninsured Children. By Families USA. (Campaign for Children’s Health Care, Washington, DC) September 2006.

["In recent years, much attention has been paid to the growing number of Americans who lack health insurance. Unfortunately, less attention has been paid to a startling and often-overlooked fact: One out of every five uninsured Americans is a child. Through no fault of their own, these youngest and most vulnerable members of society lack coverage for the health services they need to develop into healthy, productive adults. And despite the common misconception that these children somehow manage to get the care they need even though they are uninsured, the truth is that uninsured children fare far worse than their insured counterparts when it comes to a host of crucial medical services, including doctor visits, dental care, vision care, and prescription drugs."]

Key Findings: 1 p.
http://www.childrenshealthcampaign.org/tools/reports/no-shelter-key-findings.html

Full Report: 32 p.
http://www.childrenshealthcampaign.org/tools/reports/Uninsured-Kids-report.PDF

[Request #S64418]

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HUMAN SERVICES

CHILD CARE

Toward a National Strategy to Improve Family, Friend, and Neighbor Child Care: Report of a Symposium. By J. Lee Kreader and Sharmila Lawrence. (The National Center for Children in Poverty, New York, New York) September 2006. 16 p.

Full Text at: nccp.org/media/ffn06.pdf

["Family, friend, and neighbor (FFN) child care is a widely used form of care for young children in the United States, particularly for children birth through age 2. It accounts for 46 percent of the hours these youngest children spend in nonparental care. Thirty-three experts from a range of research, policy, and practice organizations came together for a symposium on FFN care on November 2, 2005 entitled: Improving Family, Friend, and Neighbor Care: Toward a National Strategy. This symposium report outlines the picture of current FFN research, practice, and policy that emerged and identifies next steps to strengthen all three areas. A major step that would support practice, policy, and research alike is to increase public awareness of the widespread use of FFN care by families of all economic levels and ethnicities."]

[Request #S64419]

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"Effects of Child-Caregiver Ratio on the Interactions Between Caregivers and Children in Child-Care Centers: An Experimental Study." By Elles J. de Schipper, J. Marianne Riksen-Walraven, and Sabine A. E. Geurts. IN: Child Development, vol. 77, no. 4. (July/August 2006) pp. 861-874.

["To investigate the effects of child-caregiver ratio on the quality of caregiver-child interactions, 217 caregivers from 64 centers were observed. A child-caregiver ratio of 3:1 produced a significantly higher quality of caregiver-child interaction than a ratio of 5:1, particularly for younger children."]

[Request #S64420]

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HOME VISITING

Implementation of Home Visitation Programs: Stories from the States. By Miriam Wasserman. Issue Brief. (Chapin Hall Center for Children, University of Chicago, Illinois) September 2006. 10 p.

["Home visiting programs that support pregnant women and families with young children have proliferated in recent decades. Chapin Hall interviewed leaders from four home visitation organizations that operate programs in multiple states. This issue brief describes the common challenges home visiting programs face: securing funding, demonstrating the efficacy of a program, and replicating successful programs in new communities." News from Chapin Hall (September 21, 2006).]

[Request #S64421]

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STUDIES TO COME
[The following studies, reports, and documents have been ordered or requested, but have not yet arrived. Requests may be placed, and copies will be provided when the material arrives.]

HEALTH

INFANTS & CHILDREN

"Health-Related Quality of Life Among 3–4-Year-Old Children Born with Very Low Birthweight." By Li-Yin Chien and others. IN: Journal of Advanced Nursing, vol. 56, no. 1 (October 2006) pp. 9-16.

["Babies with very low birth weights tend to have a much lower quality of life when they are three or four years old, according to a study published in... the UK-based Journal of Advanced Nursing. Researchers assessed 118 children who had birth weights of 1500g or less and compared them with a control group of 170 born at normal weights to compare their quality of life when it came to physical, emotional, cognitive and social functions. They discovered that the very low birth-weight children scored consistently lower scores on a scale designed to measure quality of life among pre-school children.... 'Previous studies of very low birth-weight babies have mostly focused on issues such as death, illness, neurodevelopment, growth and cognitive ability' says lead researcher Dr Li-Yin Chien.... 'Our research underlines the importance of monitoring quality of life in children with low birth weights to identify those at risk and intervene early.'" Science Daily (September 20, 2006).]

[Request #S64422]

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OBESITY

"Neurocognitive Findings in Prader-Willi Syndrome and Early-Onset Morbid Obesity." By Daniel J. Driscoll and others. IN: Journal of Pediatrics, vol. 149, no. 2 (August 2006) pp. 192-198.

["University of Florida researchers have discovered a link between morbid obesity in toddlers and lower IQ scores, cognitive delays and brain lesions similar to those seen in Alzheimer's disease patients.... Although the cause of these cognitive impairments is still unknown, UF researchers suspect the metabolic disturbances obesity causes could be taking a toll on young brains, which are still developing and not fully protected.... Researchers compared 18 children and adults with early-onset morbid obesity, which means they weighed at least 150 percent of their ideal body weight before they were 4, with 19 children and adults with Prader-Willi syndrome, and with 24 of their normal-weight siblings.... The links between cognitive impairments and Prader-Willi syndrome... are well-established. But researchers were surprised to find that children and adults who had become obese as toddlers for no known genetic reason fared almost as poorly on IQ and achievement tests as Prader-Willi patients." University of Florida (September 3, 2006).]

[Request #S64423]

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"Maternal Prompts to Eat, Child Compliance, and Mother and Child Weight Status." By Julie C. Lumeng, MD, and Lori M. Burke. IN: The Journal of Pediatrics, vol. 149, no. 3 (September 2006) pp. 330-335.

["Is there a relationship between a mother prompting her child to eat and obesity? ... Many factors contribute to childhood obesity; however, parents are in a key position to help shape children's eating behaviors and eating environments. A study in... The Journal of Pediatrics evaluates the role of mothers prompting their child to eat, the child's compliance with those prompts, and the potential contribution of each to the risk of obesity. Dr. Lumeng states that, 'A growing body of evidence suggests that maternal feeding behaviors are related to child obesity risk.' Prompting may cause the child to eat more, even when full, and therefore teach to child to ignore his/her own hunger cues. However, as Dr. Lumeng points out, 'Further work is needed to determine the developmental underpinnings of this phenomenon and the limits of its effect.'" Science Daily (September 20, 2006).]

[Request #S64424]

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VACCINES

"Parents Concerned About Vaccine Safety: Differences in Race/Ethnicity and Attitudes." By Irene M. Shui and others, Centers for Disease Control and Prevention. IN: American Journal of Preventive Medicine, vol. 31, no. 3 (September 2006) pp. 244-251.

["Parental concerns about immunization safety have been covered widely in the media and on the Internet and have been correlated in some studies with under-immunization and the late receipt of immunizations.... ConsumerStyles (2004) survey data of a nationwide panel of U.S. adults were analyzed in January 2006.... Demographics (Hispanic ethnicity/nonwhite race, low income, and less education) and negative attitudes toward immunization and the child’s healthcare provider were significantly associated with high-level concern. Seventy-two percent of parents with high-level concern responded that the risk of a child getting a disease was their primary reason for having their child immunized, while 17% listed state laws requiring immunizations for school/daycare entry. Importantly, black parents were more likely than white parents to have negative attitudes toward immunizations and their child’s healthcare provider. One fifth of parents reported high-level concern with the safety of childhood immunizations. To prevent the erosion of childhood immunization rates, healthcare providers need to learn how to recognize and address these concerns."]

[Request #S64425]

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