Deborah A Frank

Deborah A Frank
Boston University | BU · Department of Pediatrics

About

184
Publications
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Publications

Publications (184)
Poster
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This study investigated the association between food insecurity at the household or the child level and young children’s weight trajectory during their first two years of life in a diverse cohort sample of 814 households with children seeking health care from EDs in four US cities.
Article
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Objective To examine the relationship of individual and composite number of unmet basic needs (housing, energy, food, and healthcare hardships) in the past year with preterm birth status among children aged 0–24 months. Study design We examined cross-sectional 2011–18 data of 17,926 families with children aged 0–24 months. We examined children bor...
Article
Background The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) improves health outcomes for participating mothers and children. Recent immigration policy changes increased chilling effects on WIC access and utilization. Associations between WIC participation and neonatal outcomes among infants born to immigrant parent(...
Article
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Background: Addressing health-related social needs is essential for improving health and reducing longstanding disparities. However, barriers to screening – including clinician and patient time burden of screening for multiple social needs – limit identification. To address this concern and promote the uptake of screening by clinicians, it is impor...
Chapter
In 2020, there were over 50 million food insecure people living in the US, with highest rates among low-income households, families with children, and Black and Hispanic households. Food insecurity ranges from reduced quality but adequate quantity of diet to individuals with disrupted eating patterns and reduced food intake. Food insecurity exerts...
Technical Report
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When working families struggle to make ends meet with low wages, their health and well-being are adversely impacted. The Earned Income Tax Credit (EITC) and Child Tax Credit (CTC), which families can claim when they file taxes, are two of our nation's most effective programs for addressing economic strain and lifting people out of poverty. Over the...
Article
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Introduction: The Supplemental Nutrition Assistance Program (SNAP) is the largest nutrition assistance program in the U.S. This study's objective was to examine the associations between SNAP participation and young children's health and development, caregiver health, and family economic hardships. Methods: Cross-sectional data from 2006 to 2016...
Article
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Background and objectives: Food insecurity and pediatric obesity affect young children. We examine how food insecurity relates to obesity, underweight, stunting, health, and development among children <4 years of age. Methods: Caregivers of young children participated in a cross-sectional survey at medical centers in 5 US cities. Inclusion crite...
Article
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Objectives: Among US-born children of Latina US (USB) and Latina foreign-born mothers (FBM), to determine whether 1) household and child characteristics differ; 2) child health outcomes differ; 3) these differences diminish for children of FBM with longer duration of residence (DOR) in the US; and 4) these differences can be explained by food inse...
Article
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Background and objective: Children with special health care needs (SHCNs) have significant medical and educational expenses affecting household finances. Housing instability can be detrimental to family well-being. Our objective was to evaluate housing instability in households of children with and without SHCNs. Methods: Cross-sectional surveys...
Article
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The Supplemental Nutrition Assistance Program (SNAP) helps working families meet their nutritional needs. Families whose earned income increases in a given month may have their SNAP benefits abruptly reduced or cut off in the following month. Using sentinel sample data from 2007–15 for families with children younger than age four, we investigated h...
Article
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Immigrant families are known to be at higher risk of food insecurity compared to non-immigrant families. Documented immigrants in the U.S. <5 years are ineligible for the Supplemental Nutrition Assistance Program (SNAP). Immigration enforcement, anti-immigrant rhetoric, and policies negatively targeting immigrants have increased in recent years. An...
Article
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Objective: To test whether household food insecurity (HFI) was associated with total annual hospitalization charges, annual days hospitalized, and charges per day, among low-income infants (months) with any non-neonatal hospital stays. Methods: Administrative inpatient hospital charge data were matched to survey data from infants' caregivers interv...
Article
Objective: Studies examining cross-sectional associations between age at marijuana initiation and memory deficits yield mixed results. Because longitudinal data are sparse, controversy continues regarding whether these deficits reflect premorbid risk factors or sequelae of early marijuana initiation; here, we examine this question in a community s...
Article
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: media-1vid110.1542/5804912861001PEDS-VA_2017-4254Video Abstract OBJECTIVES: Prenatal homelessness is associated with elevated risks of adverse neonatal outcomes. How the timing and duration of homelessness during pregnancy and/or a child's early life relate to postnatal child health is unclear. Methods: We interviewed 20 571 low-income caregive...
Article
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Retrospective recall-based measures administered to adults, like the Childhood Trauma Questionnaire (CTQ), are commonly used to determine experiences of childhood trauma in the home. However, the CTQ has not been compared with prospective measures of childhood violence exposure, whether at home or in the community. We evaluated the relationships be...
Article
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Objectives: To evaluate how 3 forms of housing instability relate to caregiver and child health among low-income renter households. Methods: Caregivers of children 0 to 48 months of age were interviewed in 5 urban medical centers from May 2009 to December 2015. Caregivers reported on the following: caregiver health, maternal depressive symptoms,...
Article
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Introduction: This study examined how mothers' Adverse Childhood Experiences (ACEs) relate to their children's developmental risk and assessed how the association is mediated through mothers' depressive symptoms and fair/poor health. Methods: Mothers of children aged between 4 months and 4 years were recruited from the emergency department of a...
Article
Background: Executive functioning (EF), an umbrella construct encompassing gradual maturation of cognitive organization/management processes, is important to success in multiple settings including high school. Intrauterine tobacco exposure (IUTE) correlates with negative cognitive/behavioral outcomes, but little is known about its association with...
Article
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Research on the association between prenatal substance exposures and adaptive functioning among young adults is limited, with inconsistent conclusions. In a prospective longitudinal study of 138 urban young adults, prenatal substance exposures were identified at birth from maternal self-report, urine screens, and/or infant meconium. At follow-up be...
Article
Case: Pedro is a 2-year 7-month-old boy who was presented for the first time after a visit to a local emergency room (ER) for diarrhea. At the time of his birth, his undocumented mother, Clara, was 20 years old, uninsured, and with limited English proficiency living approximately 400 miles south of our practice in a different state. Although she h...
Article
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Objective: Food Insecurity (FI) occurs in 21% of families with children and adolescents in the United States, but the potential developmental and behavioral implications of this prevalent social determinant of health have not been comprehensively elucidated. This systematic review aims to examine the association between FI and childhood developmen...
Article
This manuscript reviews research exploring the relationship between prenatal, perinatal, and adolescent exposure to marijuana and aggressive behavior, including physical aggression.Areas of inquiry include animal research, as well as human research, on prenatal exposure and on marijuana use during adolescence.Potential psychosocial and psychopharma...
Article
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Introduction: Exposure to childhood adversity, including abuse, neglect, and household dysfunction, is associated with negative long-term health and economic outcomes. Little is known about how adversity exposure in parents' early lives may be related to later food insecurity for parents and their children. This study investigated the association...
Article
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Objectives: To assess food insecurity in low-income households with young children with/without special health care needs (SHCN) and evaluate relationships between child Supplemental Security Income (SSI) receipt and food insecurity. Methods: A cross-sectional survey (2013-2015) of caregivers was conducted at 5 medical centers. Eligibility inclu...
Article
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2007-2013 spanned an economic downturn with rising food costs. While Supplemental Nutrition Assistance Program (SNAP) benefits increased during those years by 13.6% from the 2009 American Recovery Reinvestment Act (ARRA), the impact of these competing conditions on household food insecurity (HFI, household food insecure but child food secure) and c...
Article
During the cocaine epidemic of the 1980s and early 1990s, many expressed fears that children with intrauterine cocaine exposure (IUCE) would grow up to be unusually violent. The present study examines the relationship of caregiver reports of school-age children's aggressive behavior with IUCE and postnatal exposure to violence. Respondents were 140...
Article
Background: Poverty is correlated with negative health outcomes in pediatric primary care, and is emerging as a negative prognostic indicator in pediatric oncology. However, measures of poverty amenable to targeted intervention, such as household material hardship (HMH)-including food, energy, and housing insecurity-have not been described in pedi...
Article
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Whether intrauterine cocaine exposure (IUCE) explains unique variance in psychiatric functioning among school age children, even after controlling for other biological and social risk factors, has not been fully delineated. As part of a longitudinal birth cohort study of children with and without IUCE, we conducted and analyzed data based on struct...
Article
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Understanding behavioral resilience among at-risk adolescents may guide public policy decisions and future programs. We examined factors predicting behavioral resilience following intrauterine substance exposure in a prospective longitudinal birth-cohort study of 136 early adolescents (ages 12.4-15.9 years) at risk for poor behavioral outcomes. We...
Article
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Housing insecurity is a known threat to child health understanding predictors of housing insecurity can help inform policies to protect the health of young children in low-income households. This study sheds light on the relationship between housing insecurity and availability of housing that is affordable to low-income households. We developed a c...
Article
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In light of recent policy debates around funding food and housing subsidies, the combined influence of these programs on housing security (HS), defined as housing without crowding or frequent moves, remains unstudied. In a multi-city study of young children, federal nutrition and housing subsidies together increased the odds of HS, whereas loss of...
Article
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Evaluate homelessness during pregnancy as a unique, time-dependent risk factor for adverse birth outcomes. 9,995 mothers of children <48 months old surveyed at emergency departments and primary care clinics in five US cities. Mothers were classified as either homeless during pregnancy with the index child, homeless only after the index child's birt...
Article
Neuropsychological processes such as attention and memory contribute to children's higher-level cognitive and language functioning and predict academic achievement. The goal of this analysis was to evaluate whether level of intrauterine cocaine exposure (IUCE) alters multiple aspects of preadolescents' neuropsychological functioning assessed using...
Article
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Objective: To ascertain measures of health status among 6- to 24-month-old children classified as below normal weight-for-age (underweight) by the Centers for Disease Control and Prevention (CDC) 2000 growth reference but as normal weight-for-age by the World Health Organization (WHO) 2006 standard. Methods: Data were gathered from children and...
Article
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This review addresses epidemiological, public health, and social policy implications of categorizing young children and their adult female caregivers in the United States as food secure when they live in households with "marginal food security," as indicated by the U.S. Household Food Security Survey Module. Existing literature shows that household...
Article
Reference: Pedro is a 2-year 7-month-old boy who was presented for the first time after a visit to a local emergency room (ER) for diarrhea. At the time of his birth, his undocumented mother, Clara, was 20 years old, uninsured, and with limited English proficiency living approximately 400 miles south of our practice in a different state. Although...
Article
Full-text available
The goal of this study was to evaluate whether intrauterine exposure to cocaine, alcohol, tobacco, or marijuana was associated with unique variance in children's academic achievement test scores after controlling for other substance exposures and contextual variables. Academic achievement scores (Wechsler Individual Achievement Test-Second Edition...
Article
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To examine how family stressors (household food insecurity and/or caregiver depressive symptoms) relate to child health and whether participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) attenuates stress-related child health risks. Cross-sectional family stress and cumulative stress models from January 1...
Poster
Full-text available
Poster presented at the 2012 Pediatric Academic Societies conference. For children birth‐24 months old, the American Academy of Pediatrics recommends the World Health Organization (WHO) 2006 growth charts derived from the 6‐country Multicentre Growth Reference Study (MGRS). Cut points were based on statistical cut points, not health outcomes. In an...
Article
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America’s low-income families struggle to protect their children from multiple threats to their health and growth. Many research and advocacy groups explore the health and educational effects of food insecurity, but less is known about these effects on very young children. Children’s HealthWatch, a group of pediatric clinicians and public health re...
Article
Full-text available
We investigated the association between housing insecurity and the health of very young children. Between 1998 and 2007, we interviewed 22,069 low-income caregivers with children younger than 3 years who were seen in 7 US urban medical centers. We assessed food insecurity, child health status, developmental risk, weight, and housing insecurity for...
Article
To ascertain whether level of intrauterine cocaine exposure (IUCE) is associated with early adolescent delinquent behavior, after accounting for prenatal exposures to other psychoactive substances and relevant psychosocial factors. Ninety-three early adolescents (12.5-14.5 years old) participating since birth in a longitudinal study of IUCE reporte...
Article
Whether intrauterine exposures to alcohol, tobacco, marijuana, or cocaine predispose offspring to substance use in adolescence has not been established. We followed a sample of 149 primarily African American/African Caribbean, urban adolescents, recruited at term birth, until age 16 to investigate intrauterine cocaine exposure (IUCE). We found that...
Article
Individual differences in adolescents' executive functioning are often attributed either to intrauterine substance exposure or to adolescents' own substance use, but both predictors typically have not been evaluated simultaneously in the same study. This prospective study evaluated whether intrauterine drug exposures, the adolescents' own substance...
Conference Paper
Background: Associations between household healthcare costs and child and maternal health are unknown, even when children are insured. State public assistance policies, including health insurance, may influence households' ability to balance healthcare expenditures and basic needs. Design/Methods: Children's HealthWatch (2007-2009) interviewed 6447...
Conference Paper
In the U.S. 17% of children age 12-17 witness and 39% are victims of violence, while 1% experience intrauterine cocaine exposure (IUCE). Although exposure to violence (EV) has been shown retrospectively to be a risk factor for earlier age of substance initiation, prospective data are limited, particularly in the context of intrauterine exposures. 1...
Article
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Hunger is the physiologic sensation that we all feel at regular intervals; it does not threaten health unless the body's need for food is consistently not met. Because scientists who evaluate the association or causal relationship of chronic hunger with child well-being are not able to reliably measure this sensation over time, the measure of food...
Article
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To develop a brief screen to identify families at risk for food insecurity (FI) and to evaluate the sensitivity, specificity, and convergent validity of the screen. Caregivers of children (age: birth through 3 years) from 7 urban medical centers completed the US Department of Agriculture 18-item Household Food Security Survey (HFSS), reports of chi...
Article
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The goals were to generate a cumulative hardship index and to evaluate its association with the well-being of children 4 to 36 months of age without private health insurance. Cross-sectional surveys were linked to anthropometric measures and medical record review at 5 urban medical centers (July 1, 2004, to December 31, 2007). Cumulative hardship i...
Article
Health care providers in clinical and research settings assess the developmental status of increasing numbers of infants and children who were prenatally exposed to drugs. Although assessment of these infants is similar to that of other at-risk infants, limitations and other issues of assessment may be overlooked given societal concerns about drug...
Article
This longitudinal study evaluated whether the level of intrauterine cocaine exposure (IUCE) or the interaction between IUCE and contextual variables was related during middle childhood to executive functioning, as assessed with the Stroop Color-Word and Rey Osterrieth Complex Figure tests. The Stroop Interference score measures verbal inhibitory co...
Article
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We investigated the risk of household food insecurity and reported fair or poor health among very young children who were US citizens and whose mothers were immigrants compared with those whose mothers had been born in the United States. Data were obtained from 19,275 mothers (7216 of whom were immigrants) who were interviewed in hospital-based set...
Article
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Household energy security has not been measured empirically or related to child health and development but is an emerging concern for clinicians and researchers as energy costs increase. The objectives of this study were to develop a clinical indicator of household energy security and assess associations with food security, health, and developmenta...
Article
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To describe the effect of wartime military deployments on the behavior of young children in military families. Cross-sectional study. Childcare centers on a large Marine base. Parents and childcare providers of children aged 1(1/2) to 5 years enrolled in on-base childcare centers. Main Exposure Parental deployment. Mean externalizing, internalizing...
Conference Paper
Background Food security has been documented as a source of concern for child health and development. While homelessness has been well-studied in relationship to food security and child health, little is known about lesser degrees of housing instability. Methods From 8/98-6/07 the Children's Sentinel Nutrition Assessment Program (C-SNAP) inte...
Article
Full-text available
The objective of this study was to use volumetric MRI to study brain volumes in 10- to 14-year-old children with and without intrauterine exposure to cocaine, alcohol, cigarettes, or marijuana. Volumetric MRI was performed on 35 children (mean age: 12.3 years; 14 with intrauterine exposure to cocaine, 21 with no intrauterine exposure to cocaine) to...