Research Spotlights: April 2023

Parental monitoring may moderate the associate between childhood environmental risk and adverse health outcomes into adulthood

Characteristics of early childhood environments are known to be associated with health trajectories over the lifespan. While adverse home environments and risky neighborhood environments are strongly linked with adverse physical and mental health outcomes as children age, a growing body of research has shown that certain parenting behaviors, such as parental monitoring, knowledge of children’s’ daily lives, and limit- or boundary-setting can have a moderating effect for at-risk youth. The discussion of parental monitoring has become more nuanced within the past two decades. If children are living in risky environments, heightened parental vigilance has been shown to be associated with fewer negative mental and physical health outcomes into adolescence and beyond. However, in lower-risk (and higher resourced) environments, this protective relationship has not been observed. In fact, in these lower-risk settings, parental monitoring and limit-setting may be associated with poor outcomes in youth. Recently published research supported by the NIH Common Fund, NIMHD, and others aimed to address this knowledge gap, by investigating longitudinal associations between early childhood environments, parental vigilance, and adult physical and mental health outcomes.

This study used longitudinal data from the National Longitudinal Survey of Youth 97. A total of 4,829 participants were included in the analysis, consisting of adolescents ages 12-14 years at the time of initial data collection in 1997 who were administered survey questions assessing physical environmental risk, parental knowledge, and parental limit-setting. In addition, Hispanic or Latino and Black adolescents were oversampled. Study data was drawn from five rounds of survey data collection, which included Rounds 1 through 3 (1997, 1998, and 1999), Round 18 (2017), and a supplemental round when participants turned 29 years.

Study analyses were surprising. Although higher-risk childhood environments were associated with adverse physical health outcomes at age 29, this association was not demonstrated for mental health outcomes at age 34. In other words, longitudinal impacts of high-risk childhood environments were limited to physical health outcomes, with a small effect size. Although no association was found with mental health outcomes, post-hoc analyses did show that maternal knowledge was a protective factor for emotional health regardless of environment risk in childhood—a finding that remains consistent with past research. Similarly, parental limit-setting had a small, but significant buffering effect for health limitations among children in high-risk environments.

There were a few study limitations; for instance, Missing data was an issue for nearly 30% of participants on outcome measures; however, analytical models were still well-powered and sensitivity analyses remained robust after imputation methods were used that accounted for missing data. In addition, measures of emotional and physical health were subjective, relying on self-report rather than objective, biological markers of health. Despite these limitations, this study makes an important contribution to our current understanding of the protective role that parenting characteristics may or may not have on child mental and physical health outcomes among children raised in high-risk environments. Future work is needed to expand the parental limit-setting construct to better understand what aspects of this characteristic may be protective. This study also has important implications for informing the inclusion of parental vigilance within resiliency-based programs for at-risk youth, given potential long-term health benefits.

Corallo KL, Carr CP, Lavner JA, Koss KJ, Ehrlich KB. The protective role of parental vigilance in the link between risky childhood environments and health. Soc Sci Med. 2023 Jan; 317:115593. doi: 10.1016/j.socscimed.2022.115593. Epub 2022 Dec 5. PMID: 36527897.

In Sub-Saharan Africa, structural biases and legal barriers might contribute to higher HIV prevalence among MSM

It is widely accepted that men who have sex with men (MSM) are adversely impacted by HIV, due to the role of public and private stigma that influence barriers to HIV prevention, diagnosis, and social support. However, there is a paucity of research investigating the associations between discriminatory public policies and structural biases and health outcomes impacting the MSM and LGBTQ communities. Supported by NIMH, NIAID, and others, researchers leveraged pooled, cross-sectional study data to conduct multilevel logistic regression to further the science regarding these associations.

Research teams collected cross sectional primary data in 10 countries, namely Burkina Faso, Cameroon, Cote d’Ivoire, the Gambia, Guinea Bissau, Nigeria, Senegal, Eswatini, Rwanda, and Togo. Individuals were recruited via respondent driven sampling supported by local civil society organizations (CSOs) and were then enrolled during specified time periods for each study between 2011 and 2020. Participants were provided with HIV testing including pre and posttest counseling in a private setting by trained staff, and sociobehavioral questionnaires were administered following HIV test results, discussion, and posttest counseling were provided. Additional HIV measures included self-reported history of HIV testing, and awareness of status among those who self-disclosed living with HIV.

On the basis of an exploratory factor analysis published in 2020, 13 stigma items (at the individual level) were combined into separate stigma scales for this analysis, including stigma related to family and friends, anticipated or perceived healthcare stigma, and general social stigma. Possible individual-level cofounders that were explored included age, education, sexual orientation, marital status, disclosure of MSM activity to friends or family, and disclosure of MSM activity to a healthcare provider. Legal environment measures consisted of country level same sex policies, based on the work developed by the HIV policy lab and the International Lesbian, Gay, Bisexual, Trans, and Intersex Association (ILGA). Country level measures included HIV community level testing, HIV population prevalence, ART coverage, and HIV disparities, and were established based on UNAIDS and WHO definitions.

While there are limitations to the methodology, given that data used is cross-sectional, and a non-probabilistic based sampling approach was used, the findings of this study are nevertheless compelling. HIV prevalence among study participants was found to be more elevated in criminalized settings versus those living in non-criminalized settings, as well as in those settings with higher recent prosecutions and barriers to CSO access. Additionally, study findings indicated that awareness of status among MSM living with HIV in this sample was far lower than Joint United Nations Programme on HIV/AIDS (UNAIDS) targets for HIV control. The study findings imply that CSOs likely play a key role in supporting healthcare access and advocacy efforts for achieving improved human rights by reducing stigma for members of the MSM and LGBTQ communities in Sub-Saharan Africa.

Lyons CE, Twahirwa Rwema JO, Makofane K, Diouf D, Mfochive Njindam I, Ba I, Kouame A, Tamoufe U, Cham B, Aliu Djaló M, Obodou EP, Karita E, Simplice A, Nowak RG, Crowell TA, Matse S, Kouanda S, Enama JP, Kavanagh M, Millett GA, Beyrer C, Murray S, Baral S. Associations between punitive policies and legal barriers to consensual same-sex sexual acts and HIV among gay men and other men who have sex with men in sub-Saharan Africa: a multicountry, respondent-driven sampling survey. Lancet HIV. 2023 Mar;10(3): e186-e194. doi: 10.1016/S2352-3018(22)00336-8. Epub 2023 Jan 6. PMID: 36623537.

Corporal punishment may impact neural systems to produce negative behavioral effects in adolescence

Decades of research has indicated that corporal punishment, defined as the use of physical pain to punish, correct, discipline, etc., can evoke a complex emotional experience in adolescents including increased anxiety, depressive symptoms, we well as increased aggressive and antisocial behavior and reduced inhibitory control and working memory capacity. Additionally, harsh parenting, characterized by high levels of control and low levels of warmth and can include corporal punishment may influence how the child’s brain responds to mistakes. Despite this previous research, the effect of corporal punishment on neurocognitive systems is not fully understood. A new study supported by the NIMH and others investigated the neural mechanisms underlying the association between corporal punishment and these adverse effects.

For this study, the researchers conducted a longitudinal study of adolescents (n = 149; ages 11-14 years of age; White (71%), African American (13%), Asian (3%), or mixed race (10%), and Hispanic ethnicity (3%)) from Tallahassee, FL, in which the participants completed a baseline visit and a follow-up visit 2 years later. Participants performed a video game-like task and a monetary guessing game while undergoing continuously recorded electroencephalography (EEG) to measure brain-wave activity. The EEG data was used to determine two scores for each participant that reflect 1) their neural response to error and 2 - their neural response to reward. Two years later, the participants and their parents completed questionnaires to screen for anxiety and depression as well as to assess parenting style.

The result of this study confirmed the findings of earlier research, demonstrating that participants who experienced lifetime corporal punishment reported more anxiety and depressive symptoms. Additionally, these participants had a larger error-related negativity and blunted reward positivity, linking corporal punishment with alterations in neural responses. Previous and ongoing work from these researchers have indicated that increased neural response to errors is associated with anxiety and risk for anxiety, whereas decreased neural response to rewards is related to depression and risk for depression.

In conclusion, this study indicates that corporal punishment may alter specific neurodevelopmental pathways that increase the risk for anxiety and depression by making adolescents hypersensitive to their errors and less reactive to rewards and positive events. The work provides new clues as to the neural underpinnings of depression and anxiety and may help inform interventions for at-risk adolescents.

Burani K, Brush CJ, Spahr C, Slavich GM, Meyer A, Hajcak G. Corporal Punishment Is Uniquely Associated with a Greater Neural Response to Errors and Blunted Neural Response to Rewards in Adolescence. Biol Psychiatry Cogn Neurosci Neuroimaging. 2023 Feb;8(2):210-218. doi: 10.1016/j.bpsc.2022.09.004. Epub 2022 Sep 21. PMID: 36152947.