Parental Practices and Environmental Differences among Infants Living in Upper-Middle and High-Income Countries: A Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants
- -
- Healthy Italian infants (H_IT): Italian infants who were not exposed to environmental risk (i.e., low SES), and were not diagnosed with any health conditions when they were evaluated. The infants were not exposed to biological risks (i.e., without prenatal (small for their gestational age, suggesting intrauterine growth restriction), and perinatal (anoxia and hypoxia) or postnatal (neurological, hearing, visual, or sensory deficits, genetic syndromes, and musculoskeletal and cardiac abnormalities) impairments.
- -
- Italian infants exposed to biological risk factors (R_IT): Italian infants prematurely born (≤37 weeks) [8].
- -
- Healthy Brazilian infants (H_BR): composed of Brazilian infants who were not exposed to environmental risk, as written for the H_IT.
- -
- Brazilian infants exposed to environmental risk factors (L_BR): Brazilian infants exposed to low SES.
2.3. Procedures and Dependent Variables
- Environmental factors: information regarding the infant’s and caregiver’s data, selected by the authors of this study. The dependent variables were: maternal age, number of children at home, number of adults at home, SES, maternal and paternal education, and civil status. The variables have been made dichotomous and qualitative (yes/no), such as the SES and civil status. Specifically, the SES for Brazilian families was determined by considering the income-to-poverty ratio (PIR) [36] and, for Italian families, according to the calculation of the poverty threshold as defined by the National Institute of Statistics [37]. In order to equalize the groups according to the countries’ income, both tools take into account the poverty level specific to the area of residence. The level of maternal and paternal education was classified according to the International Standard Classification of Education (ISCED) [38] and categorized as low (ISCED levels < 3), intermediate (ISCED levels 3–4), or high (tertiary education, ISCED levels 5–8).
- Parental practices: the area of “variety of stimulation dimension”, from the Affordances in the Home Environment for Motor Development—Infant Scale (AHEMD-IS) questionnaire [39]. It includes questions about the amount of time that the infant is awake and performing certain activities or postures, for instance, playing with other children; participating in games with practice-learning about body parts (for example, “where is your hand?”); being carried in an adult’s arms; being attached to the caregiver’s body or in some carrying device (baby bag, sling, cradleboard, etc.); in a seating device (high chair, stroller, car seat, or any other type of seating device); in a walking device (walker, exersaucer, or any other type of device that provides help for the child to walk and/or support themself while standing up); in a playpen, or other similar equipment, bed or crib; in tummy time play.
2.4. Statistical Analysis
2.5. Ethical Clearance
3. Results
3.1. Participants
3.2. Environment and Parental Practices
3.3. Environmental Factors and Parental Practices versus Variety of Stimulation
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
- 1
- 2
- 3
- 4
- 1
- 2
- 3
- 4
- Single or divorced
- Married or civil union
- Primary education
- Lower secondary education
- Upper secondary education
- Bachelor’s or equivalent level
- Master’s or equivalent level
- Doctoral or equivalent level
- Primary education
- Lower secondary education
- Upper secondary education
- Bachelor’s or equivalent level
- Master’s or equivalent level
- Doctoral or equivalent level
- <1000
- 1100–1200
- 1300–1400
- 1500–1600
- 1700–1800
- 1900–2000
- >2000
- yes
- no
- yes
- no
- never
- sometimes
- almost always
- always
- never
- sometimes
- almost always
- always
- never
- sometimes
- almost always
- always
- never
- sometimes
- almost always
- always
- never
- sometimes
- almost always
- always
- never
- sometimes
- almost always
- always
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Variables | H_IT (n = 34) | R_IT (n = 23) | H_BR (n = 31) | L_BR (n = 27) |
---|---|---|---|---|
Mother of age mean (SD) | 32.47 (3.47) | 37.39 (5.35) | 31.87 (7.10) | 24.30 (5.67) |
Number of children at home median (min–max) | 1.00 (1.00–4.00) | 2.00 (1.00–3.00) | 2.00 (1.00–3.00) | 2.00 (1.00–6.00) |
Number of adults at home median (min–max) | 2.00 (1.00–2.00) | 2.00 (2.00–3.00) | 2.00 (1.00–6.00) | 2.00 (1.00–7.00) |
Civil status/married people n (%) | 15 (44.11%) | 5 (21.73%) | 28 (90.32%) | 9 (29.03%) |
Maternal education mean (SD) | 5.41 (1.78) | 4.74 (1.66) | 4.65 (1.31) | 0.89 (0.80) |
Paternal education mean (SD) | 4.85 (1.52) | 4.78 (1.62) | 4.26 (1.44) | 1.41 (1.08) |
Variety of stimulation score mean (SD) | 12.79 (2.27) | 13.30 (1.99) | 11.68 (2.15) | 9.74 (2.31) |
Error df | F | p-Value | Partial Eta Squared | |
---|---|---|---|---|
Gestational age (weeks) | 111.00 | 2.51 | 0.06 | 0.06 |
Age at assessment | 111.00 | 0.65 | 0.58 | 0.02 |
M = 1; F = 2 | 111.00 | 0.57 | 0.63 | 0.02 |
Maternal age | 111.00 | 24.50 | 0.00 | 0.40 |
Number of children at home | 111.00 | 8.12 | 0.00 | 0.18 |
Number of the adults in the house | 111.00 | 3.81 | 0.01 | 0.09 |
Maternal education: ISCED classification | 111.00 | 56.44 | 0.00 | 0.60 |
Paternal education: ISCED classification | 111.00 | 35.99 | 0.00 | 0.49 |
Civil status (1: married or civil union, 0: no) | 111.00 | 4.15 | 0.01 | 0.10 |
SES (not Low: 1, low: 0) | 111.00 | 57.42 | 0.00 | 1.00 |
Total score of Variety of Stimulation | 111.00 | 13.84 | 0.00 | 0.27 |
Interpretation of Variety of Stimulation | 111.00 | 11.20 | 0.00 | 0.23 |
L_BR vs. R_IT | L_BR vs. H_BR | L_BR vs. H_IT | H_BR vs. R_IT | H_BR vs. H_IT | H_IT vs. R_IT | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Mean Difference [95% CI] | p-Value | Mean Difference [95% CI] | p-Value | Mean Difference [95% CI] | p-Value | Mean Difference [95% CI] | p-Value | Mean Difference [95% CI] | p-Value | Mean Difference [95% CI] | p-Value | |
Mother age | −13.10 [−17.3/−8.89] | 0.00 | −7.57 [−11.47/−3.68] | 0.00 | −8.17 [−11.99/−4.36] | 0.00 | −5.52 [−9.60/−1.45] | 0.00 | −0.60 [−4.28/−3.08] | 1.00 | −4.92 [−8.92/−0.92] | 0.01 |
Number of children at home | 1.06 [0.36/1.75] | 0.00 | 0.86 [0.22/1.50] | 0.00 | 1.02 [0.39/1.65] | 0.00 | 0.20 [−0.48/0.87] | 1.00 | 0.16 [−0.45/0.77] | 1.00 | 0.04 [−0.62/0.70] | 1.00 |
Number of adults in the house | 0.47 [−0.14/1.07] | 0.24 | 0.30 [−0.26/0.86] | 0.94 | 0.67 [0.12/1.22] | 0.01 | 0.17 [−0.42/0.76] | 1.00 | 0.38 [−0.15/0.91] | 0.36 | −0.20 [0.78/0.37] | 1.00 |
Maternal education: ISCED classification | −3.85 [−4.95/−2.75] | 0.00 | −3.76 [−4.78/−2.73] | 0.00 | −4.52 [−5.52/−3.52] | 0.00 | −0.09 [−1.16/0.98] | 1.00 | −0.77 [−1.73/0.20] | 0.21 | 0.67 [−0.38/1.72] | 0.53 |
Paternal education: ISCED classification | −3.38 [−4.46/−2.29] | 0.00 | −2.85 [−3.86/−1.84] | 0.00 | −3.45 [−4.44/−2.46] | 0.00 | −0.52 [−1.58/0.53] | 1.00 | −0.59 [−1.55/0.36] | 0.58 | 0.07 [−0.97/1.11] | 1.00 |
Civil status (1: yes, 0: no) | 0.03 [−0.28/0.34] | 1.00 | −0.12 [−0.41/0.16] | 1.00 | 0.23 [−0.05/0.51] | 0.19 | 0.15 [−0.15/0.45] | 1.00 | 0.35 [0.08/0.62] | 0.01 | −0.19 [−0.49/0.10] | 0.46 |
SES (not low: 1, low: 0) | −1.00 [−1.00/−1.00] | 0.00 | −1.00 [−1.00/−1.00] | 0.00 | −1.00 [−1.00/−1.00] | 0.00 | 0.00 [0.00/0.00] | 1.00 | 0.00 [0.00/0.00] | 1.00 | 0.00 [0.00/0.00] | 1.00 |
Total score of Variety of Stimulation | −3.56 [−5.24/−1.89] | 0.00 | −1.94 [−3.49/−0.39] | 0.01 | −3.05 [−4.47/−1.53] | 0.00 | −1.63 [−3.25/0.00] | 0.05 | −1.12 [−2.58/0.35] | 0.26 | −0.51 [−2.10/1.08] | 1.00 |
Interpretation of Variety of Stimulation | −1.35 [−2.08/−0.63] | 0.00 | −0.71 [−1.38/−0.03] | 0.04 | −1.22 [−1.88/−0.56] | 0.00 | −0.65 [−1.35/0.06] | 0.09 | −0.52 [−1.15/0.12] | 0.19 | −0.13 [−0.82/0.56] | 1.00 |
I/We Regularly (at Least Twice a Week) Play Games with my/our Child to Practice Learning about Body Parts. (e.g., Where Is Your Hand?) | My/our Baby Plays Regularly (at Least Twice a Week) with Other Children | Carried in Adult Arms, Attached to Caregiver’s Body or in some Carrying Device (Baby Bag, Sling, Cradleboard, etc). | In a Seating Device (High Chair, Stroller, Car Seat, or any Other Type of Seating Device). | In a Walking Device (Walker, Exersaucer, or any Other Type of Device that Provides Help for the Child to Walk and/or Support While Standing up). | In a Playpen, or Other Similar Equipment, Bed or crib. | In the Tummy Time Play. | Free to Move in any Space of the House | Total Score of Variety of Stimulation | |
---|---|---|---|---|---|---|---|---|---|
Age at assessment | 0.016 | 0.004 | 0.045 | 0.069 | 0.043 | −0.001 | 0.041 | 0.270 ** | 0.203 * |
Sex | 0.019 | −0.127 | 0.101 | −0.171 | −0.009 | −0.074 | −0.009 | −0.008 | −0.088 |
maternal age | 0.137 | 0.093 | 0.095 | −0.059 | −0.015 | −0.076 | 0.317 ** | 0.469 ** | 0.344 ** |
number of children at home | −0.288 ** | 0.211 * | 0.049 | −0.114 | 0.044 | −0.129 | −0.188 * | −0.190 * | −0.232 ** |
number of the adults in the house | 0.019 | 0.019 | −0.058 | 0.137 | 0.082 | 0.114 | −0.176 * | −0.225 ** | −0.071 |
Maternal schoolarity: ISCED classification | 0.271 ** | 0.048 | 0.054 | 0.013 | 0.054 | 0.056 | 0.333 ** | 0.455 ** | 0.428 ** |
Paternal schoolarity:ISCED classification | 0.205 * | 0.086 | 0.006 | 0.017 | 0.063 | 0.020 | 0.199 * | 0.363 ** | 0.287 ** |
civil status | −0.141 | 0.018 | 0.192 * | −0.078 | −0.024 | 0.085 | −0.096 | −0.002 | −0.019 |
SES | 0.299 ** | 0.033 | 0.024 | −0.004 | 0.048 | 0.003 | 0.420 ** | 0.531 ** | 0.484 ** |
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Fioroni Ribeiro da Silva, C.; Menici, V.; Tudella, E.; Beani, E.; Barzacchi, V.; Battini, R.; Orsini, A.; Cioni, G.; Sgandurra, G. Parental Practices and Environmental Differences among Infants Living in Upper-Middle and High-Income Countries: A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2022, 19, 10833. https://doi.org/10.3390/ijerph191710833
Fioroni Ribeiro da Silva C, Menici V, Tudella E, Beani E, Barzacchi V, Battini R, Orsini A, Cioni G, Sgandurra G. Parental Practices and Environmental Differences among Infants Living in Upper-Middle and High-Income Countries: A Cross-Sectional Study. International Journal of Environmental Research and Public Health. 2022; 19(17):10833. https://doi.org/10.3390/ijerph191710833
Chicago/Turabian StyleFioroni Ribeiro da Silva, Carolina, Valentina Menici, Eloisa Tudella, Elena Beani, Veronica Barzacchi, Roberta Battini, Alessandro Orsini, Giovanni Cioni, and Giuseppina Sgandurra. 2022. "Parental Practices and Environmental Differences among Infants Living in Upper-Middle and High-Income Countries: A Cross-Sectional Study" International Journal of Environmental Research and Public Health 19, no. 17: 10833. https://doi.org/10.3390/ijerph191710833