“Poverty, Toxic Stress, and Education…” Study by Kelly & Li

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Table of Contents

Research problem
Literature review
Sample
Variables
Results
References

Much of modern research is dedicated to studying factors that influence the health and neurodevelopment of children. Preterm birth, defined as birth before 37 completed weeks of gestation, has been discerned as a global epidemic with significant psychosocial, economic and physical effects. The 2019 study “Poverty, Toxic Stress, and Education in Children Born Preterm” aims to determine the statistical relationship between premature births and developmental issues. The study is an interesting basis for further research but is ultimately undermined by its inefficient design.

Research problem

The problem statement is easily located with a simple read-through of the introduction. Kelly and Li (2019) are concerned with the lack of research about poverty and toxic stress affecting the neurodevelopment of preterm children. There is clear significance to the question, given that an estimated 15 million babies are born preterm every year, and the number is expected to increase (Wallani, 2020). In case of a definite correlation between preterm births and developmental delays, adequate healthcare and educational measures must be established. The authors also mention that black women are 60% more likely to deliver preterm, signifying that preterm research can help address racial disparities in healthcare.

According to The American Journal of Maternal Nursing, nurses play the essential role of bedside experts, advocates, and educators when caring for women undergoing preterm labor and birth (Cypher et al., 2020). If the causal relationship between preterm birth and decreased neurodevelopmental and educational outcomes is proven, nurses can provide this critical information to women at risk so they can make well-informed decisions about future pregnancies (Maloni & Damato, 2004). As preterm birth rates rise, nurses must be clinical and professional experts in preterm birth to help their patients make well-informed decisions about their pregnancy.

Literature review

The authors adequately summarize previous relevant studies. The evolution of research is presented in a logical, easily understandable sequence. Adverse childhood experiences (ACEs) such as abuse, neglect, and family dysfunction, cause the prolonged activation of a body’s stress response and result in toxic stress. Toxic stress disrupts brain circuitry, metabolic systems, and the capacity to adapt to future adversity. The eco-bio-developmental (EBD) framework tracks the implications of toxic stress on future behavioral, educational, economic, and health outcomes. The authors clearly state the gap in the existing literature to explore the application of the EBD model on preterm births.

The research question or hypothesis is not stated openly. The authors state that their goal is to evaluate the association between poverty, toxic stress, and prematurity on neurodevelopmental and educational outcomes. Based on their previous literature review, it can be inferred that premature birth is expected to affect cognitive development negatively.

Sample

The study analyzed a subset of data compiled by the U.S. Census Bureau from the 2016 National Survey of Children’s Health. The 2016 NSCH initially required a guardian to submit the age and gender of all children in the household before randomly selecting one child to be the subject of the main questionnaire. 50,212 detailed questionnaires were completed out of the initial 139,923. Kelly and Li (2019) used the data for children 6-11 years old to reflect elementary school experiences, which amounted to 15,010 reports.

There were minimal ethical or legal issues, given that the data was voluntary and self-administered. However, self-reported voluntary questionnaires are likely to result in a sample that does not represent the general population; volunteer bias is a confirmed psychological phenomenon. The authors did not compile the data themselves or choose a method of sampling that addressed the needs of the study. They merely analyzed the data already gathered by the 2016 NSCH. Secondary data analysis limits the opportunity to ask in-depth, focused questions and merely shows a vague correlation, not a causal relationship. Moreover, the study does not specify how the U.S. Census Bureau selected the initial sample of 139,923 or why elementary school experiences were prioritized.

Variables

Predictor variables included prematurity, poverty, and toxic stress. A positive response to the question “Was your child born prematurely?” determined prematurity. Poverty was defined as living with an income below the federal poverty line issued by the Department of Health and Human Services. The child was diagnosed with toxic stress if their guardian reported that the child had experienced at least one Adverse Childhood Experience, such as: divorced/incarcerated/dead parents, witnessing domestic or neighborhood violence, family mental illness or substance abuse, and racial or ethnic discrimination.

Demographic control variables included gender of the child, insurance coverage status, race, and the highest level of education of the child’s primary guardians.

Neurodevelopmental outcome variables included developmental delay, intellectual disability, speech or other language disorder, learning disability, autism, and ADHD. Repeating a grade and receiving special education/early intervention plan were considered educational outcome variables. The guardian’s self-report determined both sets of variables.

The method chosen to measure poverty, neurodevelopmental and educational outcomes seems appropriate. However, diagnosing children with toxic stress if they have suffered even one Adverse Childhood Experience seems extreme, and there is insufficient research to support such a strategy. Is it fair to diagnose a child with disrupted brain circuitry only because their parents are divorced? Furthermore, guardians may be unaware of the child’s exposure to Adverse Childhood Experience or hesitant to report it to the U.S. Census Bureau. The study also does not control several other factors contributing to developmental disabilities, such as parental behavior during pregnancy, genetic predisposition, or environmental toxins.

Results

Pearson’s chi-square test and logistic regression modeling were used to examine the effect of prematurity and toxic stress on neurodevelopmental and educational outcomes. Appropriate statistics were clearly presented, and tables were well-organized and easy to understand.

Results showed that preterm children experience a higher incidence of toxic stress, poverty, and significantly decreased developmental and educational outcomes when controlling for demographic factors. Kelly and Li (2019) recommend that healthcare providers organize program interventions and policies to address the “tripartite vulnerability” of children suffering from weak physical constitutions due to preterm birth, disrupted brain function related to poverty, and negative physiological effects of toxic stress. However, given the limitations of the study’s data collection method and subsequent metrics, the study result does not appear to effectively resolve the question it asked. The results are rendered invalid by the inadequate data collection. The procedure was thoughtfully carried out, but its reliance on limited secondary data ultimately undermined it.

In conclusion, this 2019 study provides a loose correlation between preterm birth, toxic stress, poverty, and decreased neurodevelopmental and educational outcomes. It is not a rigorous or trustworthy study due to its poor data collection method, which depends on secondary sources and fails to consider other contributing factors. This research serves as a stimulus for further research into preterm births but does not yet translate to meaningful evidence useful for nursing practice.

References

Cypher, R., Griggs, K. M., Hrelic, D. A., McEwen-Campbell, M., Williams, N. (2020). Preterm labor and birth: A clinical review. MCN: The American Journal of Maternal/Child Nursing, 45(6), 328-337.

Damato, E. G., & Maloni, J. A. (2004). Reducing the risk for preterm birth: evidence and implications for neonatal nurses. Advances in Neonatal Care, 4(3), 166-174.

Kelly, M. M., & Li, K. (2019). Poverty, toxic stress, and education in children born preterm. Nursing research, 68(4), 275-284.

Walani, S. R. (2020). Global burden of preterm birth. International Journal of Gynecology & Obstetrics, 150(1), 31-33.

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