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Scholarly Works (23 results)

  • Article
  • Peer Reviewed
UC Irvine Previously Published Works (2023)
Investigation of health inequities tend to be examined, in human neurosciences, as biological factors at the level of the individual. In actuality, health inequities arise, due largely in part, to deep-seated structural factors. Structural inequality refers to the systemic disadvantage of one social group compared to others with whom they coexist. The term encompasses policy, law, governance, and culture and relates to race, ethnicity, gender or gender identity, class, sexual orientation, and other domains. These structural inequalities include but are not limited to social segregation, the intergenerational effects of colonialism and the consequent distribution of power and privilege. Principles to address inequities influenced by structural factors are increasingly prevalent in a subfield of the neurosciences, i.e., cultural neurosciences. Cultural neuroscience articulates the bidirectional relationship between biology and environmental contextual factors surrounding research participants. However, the operationalization of these principles may not have the intended spillover effect on the majority of human neurosciences: this limitation is the overarching focus of the present piece. Here, we provide our perspective that these principles are missing and very much needed in all human neuroscience subdisciplines to accelerate our understanding of the human brain. Furthermore, we provide an outline of two key tenets of a health equity lens necessary for achieving research equity in human neurosciences: the social determinants of health (SDoH) framework and how to deal with confounders using counterfactual thinking. We argue that these tenets should be prioritized across future human neuroscience research more generally, and doing so is a pathway to further gain an understanding of contextual background intertwined with the human brain, thus improving the rigor and inclusivity of human neuroscience research.
    Cover page: A call to leverage a health equity lens to accelerate human neuroscience research.
    • Article
    • Peer Reviewed
    UC Irvine Previously Published Works (2023)

    Introduction

    Salivary bioscience has found increased utilization within pediatric research, given the non-invasive nature of self-collecting saliva for measuring biological markers. With this growth in pediatric utility, more understanding is needed of how social-contextual factors, such as socioeconomic factors or status (SES), influence salivary bioscience in large multi-site studies. Socioeconomic factors have been shown to influence non-salivary analyte levels across childhood and adolescent development. However, less is understood about relationships between these socioeconomic factors and salivary collection methodological variables (e.g., time of saliva collection from waking, time of day of saliva collection, physical activity prior to saliva collection, and caffeine intake prior to saliva collection). Variability in salivary methodological variables between participants may impact the levels of analytes measured in a salivary sample, thus serving as a potential mechanism for non-random systematic biases in analytes.

    Methods

    Our objective is to examine relationships between socioeconomic factors and salivary bioscience methodological variables within the Adolescent Brain Cognitive Development Study© cohort of children aged 9-10 years old (n = 10,567 participants with saliva samples).

    Results

    We observed significant associations between household socioeconomic factors (poverty status, education) and salivary collection methodological variables (time since waking, time of day of sampling, physical activity, and caffeine intake). Moreover, lower levels of household poverty and education were significantly associated with more sources of potential bias in salivary collection methodological variables (e.g., longer times since waking, collections later in the day, higher odds of caffeine consumption, and lower odds of physical activity). Consistent associations were not observed with neighborhood socioeconomic factors and salivary methodological variables.

    Discussion

    Previous literature demonstrates associations between collection methodological variables and measurements of salivary analyte levels, particularly with analytes that are more sensitive to circadian rhythms, pH levels, or rigorous physical activity. Our novel findings suggest that unintended distortions in measured salivary analyte values, potentially resulting from the non-random systematic biases in salivary methodology, need to be intentionally incorporated into analyses and interpretation of results. This is particularly salient for future studies interested in examining underlying mechanisms of childhood socioeconomic health inequities in future analyses.
      Cover page: The implications of socioeconomic factors on salivary bioscience methodological variables in a large pediatric multi-site study
      • Thesis
      • Peer Reviewed
      UC Irvine Electronic Theses and Dissertations (2023)

      ABSTRACT OF DISSERTATIONInvestigating the Impact of Prenatal Exposure to Hypertensive Disorders of Pregnancy on Adolescent Neurodevelopment and Pubertal Maturation: A Study of Neuroimaging and Salivary Biological Measures. By Vida Bobela Fabiola Rebello Doctor of Philosophy in Public Health University of California, Irvine, 2023 The increasing prevalence of hypertensive disorders of pregnancy (HDP), including specific types of HDP like pregnancy-related hypertension (PR-HTN), preeclampsia, and eclampsia (P/E), pose significant health risks for pregnant individuals and their offspring. Although, prenatal HDP exposure has been reported to augment children’s sensitivity to adverse health outcomes, few studies have examined the long-term associations of prenatal exposure to HDP on neurodevelopment and hormone profiles beyond childhood. Adolescence is a critical period during which both the brain and the endocrine system undergo substantial development, representing a core risk period for when HDP-related differences may become discernable. Previous studies on the impact of HDP on adolescent health have primarily focused on discrete populations (e.g., clinical, low prevalence populations) exposed to a single type of HDP, predominantly preeclampsia. Moreover, these studies have been constrained by the lack of prospective follow-up and insufficient consideration of potential mediators. Elucidating the biophysiological mechanisms that demonstrate long-term postnatal alterations following prenatal exposure to HDP is needed. Therefore, the objective of this dissertation was to identify biological measures pertinent to psychopathology and metabolic risks influenced by HDP and to examine the role of HDP types in these relationships, utilizing the Developmental Origins of Health and Disease (DOHaD) framework. Data from the longitudinal Adolescent Brain Cognitive Development (ABCD) Study© was used, including approximately 11,888 adolescents aged 9-10 years at baseline. In Chapter 2, direct and indirect associations between HDP and cortical and subcortical brain structures were examined while accounting for the mediating role of intracranial volume in adolescents, using structural magnetic resonance imaging (sMRI) measures at two timepoints: baseline and year 2 follow-up. In chapter 3, diffusion weighted MRI (dMRI) measures were employed at two time points (baseline and Year 2 follow-up) to assess whether prenatal exposure to HDP contributes to white matter connectivity differences among the adolescents. In chapter 4, the influence of HDP on long-term endocrine development focusing in on androgen hormone profiles were investigated at three timepoints: baseline, year 1 follow-up and year 2 follow-up among the adolescents. HDP exposure was categorized as pregnancy-related hypertension (PR-HTN), preeclampsia/eclampsia (P/E), or unexposed (no HDP). Hierarchical mixed effects models were used to account for the multilevel data structure, and analyses were stratified by biological sex. In Chapter 1, findings demonstrate direct and indirect impact of prenatal exposure to HDP on the development of cortical and subcortical brain structure, identifying distinct variations in the impact of prenatal HDP exposure on neurodevelopment, with the observed associations being sex-dependent. Specifically, the unique consequences of the two distinct HDP types on brain structures differed between males and females. In chapter 2, further evidence is presented, illustrating that HDP exposure, particularly PR-HTN, is a significant predictor of alterations in white matter development. This association was observed exclusively among female adolescents, potentially because of the earlier onset of puberty-related initiation of myelination of white matter in females. Chapter 4 revealed distinct androgenic hormonal patterns in both males and female adolescents to the two types of HDP exposures. Collectively, this dissertation addresses the gap in our understanding of the unique ways in which PR-HTN and P/E influence adolescent neuroendocrine development. It underscores the importance of early monitoring and intervention for neurodevelopment and pubertal maturation to address potential pathological deviations that could lead to neuropsychiatric and metabolic disorders later in life. Additionally, this dissertation emphasizes the need to consider community-level hypertension in preconceptual health, as increased resources could benefit both the pregnant individuals and the child. Furthermore, it highlights the importance of accounting for prenatal HDP exposure when investigating adolescent neurodevelopment and pubertal maturation. Future research is warranted to elucidate the long-term disease outcomes associated with HDP.

        Cover page: Investigating the Impact of Prenatal Exposure to Hypertensive Disorders of Pregnancy on Adolescent Neurodevelopment and Pubertal Maturation: A Study of Neuroimaging and Salivary Biological Measures.
        • Thesis
        • Peer Reviewed
        UC Irvine Electronic Theses and Dissertations (2020)

        Background: Physicians die by suicide at a rate that is higher than the general population. This increased risk for suicide may begin during medical school. Medical students experience depression and suicidal thoughts and behaviors at a higher rate than their age-matched peers. This dissertation examines biopsychosocial risk factors for depression and suicidality in a sample of medical students. This dissertation also explores the use of salivary biomarkers as screening tools for mental distress by examining associations between indicators of depression and suicidality, salivary cortisol, and salivary C-reactive protein (CRP). Methods: An in-person, self-report survey was completed by 134 medical students. The survey contained questions about sociodemographic characteristics, family history of depression and suicide, and validated measures of health behaviors and psychosocial well-being. Participants also completed two consecutive days of saliva collection at home. Saliva samples were returned by 109 (81%) of the 134 medical students enrolled in the study. Cortisol and CRP were assayed from whole saliva in duplicate. Chapter 2 characterizes the prevalence of indicators of mental distress and potential risk factors, and examines sex differences using chi-square and Mann Whitney U tests. Additionally, associations between indicators of mental distress and potential risk factors including perceived stress, sleep quality, impostor syndrome, alcohol abuse, and financial distress (e.g. difficulty paying bills, financial need, and food insecurity) are examined using logistic regression. Chapter 3 examines associations between daily cortisol activity (i.e., daily output and diurnal slope) and indicators of mental distress using a linear multilevel model to asses variation in cortisol activity across people, sampling days, and individual salivary assessments. Chapter 4 explores associations between mental distress indicators and: 1) inflammatory activity (i.e., waking and evening CRP and diurnal CRP slope) using logistic regression and 2) the coordination between hypothalamic-pituitary-adrenal axis (HPA) and inflammatory function (i.e., waking and evening cortisol/CRP, the interaction between area under the curve with respect to ground (AUCg) for cortisol and CRP, and the interaction between diurnal slopes for cortisol and CRP). Sex-specific differences in waking and evening cortisol/CRP between mental distress groups (i.e., positive versus negative DS) are examined using Mann-Whitney U test. The interaction of cortisol AUCg and CRP AUCg and the interaction between cortisol diurnal slope and CRP diurnal slope are explored through logistic regression. Results: I found a high prevalence of DS, SI, history of suicidality, and factors shown to increase risk for suicide (i.e., poor sleep quality, high perceived stress and impostor syndrome, and high alcohol use). Positive DS was associated with high perceived stress, poor sleep quality, impostor syndrome, and bill payment difficulty after adjustment for demographic covariates and family history of depression. SI and suicide risk were associated with impostor feelings even after adjustment, and history of suicidality was associated with impostor feelings and poor sleep quality even after adjustment. I also found that suicide risk was associated with higher diurnal cortisol output. Additionally, I found that waking CRP was positively associated with SI in males and females and DS in males, and negatively associated with suicide risk in females. Higher waking cortisol/CRP was also associated with a positive DS and suicide risk in females. The interaction between cortisol and CRP activity (i.e., AUCg and diurnal slope) was not associated with mental distress. Conclusion: These findings suggest a high prevalence of factors that are associated with increased risk for suicide in this sample, and that sleep quality, perceived stress, feelings of impostor syndrome, and bill payment difficulty may be important targets for future intervention studies in medical students. Additionally, this dissertation provides preliminary evidence that HPA and inflammatory activity are disrupted in a sample of young adults with mental distress. Future longitudinal research is needed to assess temporality of these findings, confirm these associations in a larger study sample, and provide additional evidence to inform mental health intervention and prevention efforts in this high-risk population.

          • Thesis
          • Peer Reviewed
          UC Irvine Electronic Theses and Dissertations (2024)

          Multiple leading perinatal health organizations recommend the feeding of human milk (e.g., via breastfeeding) as the optimal form of infant feeding during at least the first 6 months of life. These recommendations are supported by extensive evidence of the health benefits for both the infant and the mother throughout the lifecourse, including reduced risk of chronic and infectious disease. However, racial disparities, marked by reduced breastfeeding initiation and duration rates, have persisted among Black/African-American mothers compared to other racial/ethnic groups in the United States. Even with documented historical and current lived experiences of racism specific to this group, there is a paucity of investigations examining the contribution of racism as a potential barrier towards breastfeeding goals among Black/African-American families. Current evidence also lacks examinations of spirituality, religiosity, and social network resources that may influence breastfeeding within this population. Further, even less is known about shared relationships between racism and supportive resources in mitigating breastfeeding outcomes.

          This research addresses knowledge gaps through a secondary analysis of the Community and Child Health Network (CCHN) dataset focused on the sample of Black/African-American participants. This research ultimately advances the understanding of racism-related and resource-related mechanisms of breastfeeding initiation and duration among Black/African-American families.

          Chapter 1 of this dissertation presents a review of the current literature of this topic by reviewing definitions presented throughout the document, reviewing racial disparities in infant feeding (e.g., specifically breastfeeding), and reviewing sociodemographic trends as it relates to breastfeeding. Lastly, Chapter 1 provides an overview of the theoretical framework informing this dissertation.

          Chapter 2 examines the characterization of social networks among Black/African American mothers and further relates these typologies to breastfeeding outcomes. Results indicate heterogenous social networks among Black/African American mothers in the CCHN dataset. Further, these social networks relate to breastfeeding where mothers with networks characterized by high levels of influence and support for breastfeeding are significantly more likely to initiate breastfeeding and breastfeed for longer, compared to mothers with networks characterized by low/moderate levels of influence and low levels of support for breastfeeding.

          Chapter 3 of this dissertation elucidates the contribution of interpersonal racial discrimination (e.g., youth, everyday, healthcare, job, education, police, housing) on breastfeeding initiation and duration among Black/African-American mothers. Contrary to the hypothesis,significantly higher likelihoods of breastfeeding initiation were observed among mothers who endorsed experiences of racial discrimination during youth, everyday adulthood, in police-related settings, and in healthcare-related settings, compared to mothers who denied these experiences. However, these relationships were observed to be partially moderated by social support networks (Chapter 2). Mothers reporting moderate-high levels of racial discrimination yet receiving support from diverse network members (high influence and high support), demonstrated a higher likelihood of breastfeeding initiation compared to mothers reporting low levels of discrimination.

          Chapter 4 elucidates the contribution of individual and interpersonal resources (e.g., spirituality, religiosity, social support) on breastfeeding initiation and duration among Black/African-American mothers. Findings are generally in support of the hypothesis, where higher spirituality and religiosity scores were significantly associated with breastfeeding initiation and duration. However, when accounting for sociodemographic characteristics in fully-adjusted models, spirituality was consistently associated with higher likelihoods of breastfeeding initiation and longer durations. Religiosity remained associated with higher likelihoods of breastfeeding initiation, but relationships were attenuated for breastfeeding duration. Also, contrary to the hypothesis, domains of social support (emotional/informational, affectionate, tangible, positive social interactions) were not significantly related to breastfeeding initiation. Further contrary to the hypothesis, increasing scores of emotional/informational, tangible, and positive social interaction domains were related to lower likelihoods of breastfeeding initiation and shorter durations. In summary, Chapter 4 identifies novel spiritual and religious resources that can be leveraged in interventions to promote breastfeeding. There appears to be differential effects of individual and interpersonal resources on breastfeeding initiation versus duration. This implies that xiithe mechanism of supportive resources to start breastfeeding may de different than mechanisms to continue breastfeeding.

          The significance of this research contributes to nuanced understanding of barriers and resiliency among Black/African American families. Additionally, this research identifies novel targets for infant feeding interventions among Black/African-American families by elucidating the relationship between racism (e.g., barriers) and resources with regard to breastfeeding.

            Creative Commons 'BY-NC-ND' version 4.0 license
            • Article
            • Peer Reviewed
            UC Irvine Previously Published Works (2023)
            INTRODUCTION: Physicians die by suicide at rates higher than the general population, with the increased risk beginning in medical school. To better understand why, this study examined the prevalence of mental distress (e.g., depressive symptoms and suicide risk) and behavioral and psychosocial risk factors for distress, as well as the associations between mental distress and risk factors among a sample of medical students in a pre-COVID-19-era. METHODS: Students enrolled in a large California medical school in 2018-2019 (N = 134; 52% female) completed questionnaires assessing sociodemographic characteristics, depression and suicide family history, health behaviors, and psychosocial wellbeing. Assessment scores indexing mental distress (e.g., depressive symptoms, thoughts of suicide in the past 12 months, suicide risk, and history of suicidality) and risk factors (e.g., stress, subjective sleep quality, alcohol use, impostor feelings, and bill payment difficulty) were compared across biological sex using chi-squared tests, and associations between mental distress and risk factors were determined through logistic regression. RESULTS: Elevated mental distress indicators were observed relative to the general public (e.g., 16% positive depression screen, 17% thought about suicide in previous 12 months, 10% positive suicide risk screen, and 34% history of suicidality), as well as elevated risk factors [e.g., 55% moderate or high stress, 95% at least moderate impostor feelings, 59% poor sleep quality, 50% screened positive for hazardous drinking (more likely in females), and 25% difficulty paying bills]. A positive depression screen was associated with higher stress, higher impostor feelings, poorer sleep quality, and difficulty paying bills. Suicidal ideation in the previous 12 months, suicide risk, and a history of suicidality were independently associated with higher levels of impostor feelings. DISCUSSION: Higher scores on assessments of depressive symptoms and suicidal thoughts and behaviors were related to several individual-level and potentially modifiable risk factors (e.g., stress, impostor feelings, sleep quality, and bill payment difficulties). Future research is needed to inform customized screening and resources for the wellbeing of the medical community. However, it is likely that the modification of individual-level risk factors is limited by the larger medical culture and systems, suggesting that successful interventions mitigate suicide risk for medical providers need to address multiple socio-ecological levels.
              Cover page: Behavioral and psychosocial factors related to mental distress among medical students.
              • Article
              • Peer Reviewed
              UC Irvine Previously Published Works (2017)
              Emerging evidence in the field of adolescent neurodevelopment suggests that pubertal processes may contribute to known trajectories of brain maturation, and may contribute, in part, to sex differences in related cognitive, behavioral and mental health outcomes. The current longitudinal study examined how changes in physical pubertal maturation (measured by the Peterson Developmental Scale) predict changes in white matter microstructure in 18 boys and 15 girls over an approximate 2-year follow-up period, while accounting for age. Using Tract-Based Spatial Statistics and multi-level modeling, the results showed that physical pubertal changes predict patterns of changes in fractional anisotropy (FA) in white matter regions in the thalamus, precentral gyrus, superior corona radiata, corpus callosum (genu), superior corona radiata, and superior frontal gyrus. Sex specific changes were also seen, as changes in gonadal and adrenal development related to increases in FA in the superior frontal gyrus and precentral gyrus in boys, but gonadal development related to decreases in FA in the anterior corona radiata in girls. These findings are the first to show how changes over time in pubertal development influence white matter development. In addition, they support a larger body of emerging research suggesting that pubertal processes contribute to distinct changes in boys and girls across brain development.
                Cover page: Longitudinal changes in pubertal maturation and white matter microstructure
                • Article
                • Peer Reviewed
                UC Irvine Previously Published Works (2015)

                Rationale

                Individuals with fetal alcohol spectrum disorder (FASD) are at increased risk for substance use disorders (SUD). In typically developing individuals, susceptibility to SUD is associated with alterations in dopamine and hypothalamic-pituitary-adrenal (HPA) systems, and their interactions. Prenatal alcohol exposure (PAE) alters dopamine and HPA systems, yet effects of PAE on dopamine-HPA interactions are unknown. Amphetamine-stress cross-sensitization paradigms were utilized to investigate sensitivity of dopamine and stress (HPA) systems, and their interactions following PAE.

                Methods

                Adult Sprague-Dawley offspring from PAE, pair-fed, and ad libitum-fed control groups were assigned to amphetamine-(1-2 mg/kg) or saline-treated conditions, with injections every other day for 15 days. Fourteen days later, all animals received an amphetamine challenge (1 mg/kg) and 5 days later, hormones were measured under basal or acute stress conditions. Amphetamine sensitization (augmented locomotion, days 1-29) and cross-sensitization with acute restraint stress (increased stress hormones, day 34) were assessed.

                Results

                PAE rats exhibited a lower threshold for amphetamine sensitization compared to controls, suggesting enhanced sensitivity of dopaminergic systems to stimulant-induced changes. Cross-sensitization between amphetamine (dopamine) and stress (HPA hormone) systems was evident in PAE, but not in control rats. PAE males exhibited increased dopamine receptor expression (medial prefrontal cortex (mPFC)) compared to controls.

                Conclusions

                PAE alters induction and expression of sensitization/cross-sensitization, as reflected in locomotor, neural, and endocrine changes, in a manner consistent with increased sensitivity of dopamine and stress systems. These results provide insight into possible mechanisms that could underlie increased prevalence of SUD, as well as the impact of widely prescribed stimulant medications among adolescents with FASD.
                  Cover page: Amphetamine sensitization and cross-sensitization with acute restraint stress: impact of prenatal alcohol exposure in male and female rats
                  • Article
                  • Peer Reviewed
                  UC Irvine Previously Published Works (2020)
                  The positive relationship between socioeconomic status (SES) and cognitive performance is mediated, in part, by differences in brain structure in typically developing youth. Associations between brain regions that relate to SES overlap with brain regions known to be sensitive to prenatal alcohol exposure (PAE). Animal models demonstrate that PAE attenuates neural and cognitive benefits of early life enrichment. However, whether or not environmental factors related to SES are associated with brain development in youth affected by PAE remains unknown in humans.

                  Methods

                  T1-weighted magnetic resonance imaging (MRI) scans were obtained in participants with PAE and compared to age- and sex- matched Controls (n = 197, 48% with PAE, 44% girls, 6.5-17.7 years old). General linear modeling was utilized to examine associations between SES and subcortical brain volumes for youth with PAE compared to Controls.

                  Results

                  Group by SES interactions were observed within the hippocampus (HPC), nucleus accumbens (NAc) and ventral diencephalon (vDC) (corrected p values <0.05), where positive associations (e.g., higher SES related to larger subcortical volumes) were observed within Controls, but not youth with PAE. Post hoc analyses examined associations between SES and brain volumes within each group independently, and revealed widespread positive associations among Controls (Amyg, HPC, NAc, Pallidum, Putamen, vDC), but not youth with PAE. Across both groups, larger subcortical volumes were related to higher cognitive performance.

                  Conclusion

                  Typically developing youth exhibit increased subcortical volumes with increased SES, and surprisingly, this relationship is absent in adolescents with PAE. Findings suggest that subcortical brain volumes are neurocognitively relevant in both groups. The present results expand our understanding of the impact of PAE on the developing human brain within varying environmental contexts, and may inform novel environmental interventions that aim to improve, in part, on-going disruptions in brain development among youth with PAE. Our study highlights novel complexities in the pursuit to understand SES-brain associations, as we provide evidence that SES matters for brain outcomes among typically developing youth, and possibly not as much on an already altered brain as a result of PAE.
                    Cover page: The Relationship Between Socioeconomic Status and Brain Volume in Children and Adolescents With Prenatal Alcohol Exposure
                    • Article
                    • Peer Reviewed
                    UC San Diego Previously Published Works (2020)
                    While low socioeconomic status (SES) introduces risk for developmental outcomes among children, there are an array of proximal processes that determine the ecologies and thus the lived experiences of children. This study examined interrelations between 22 proximal measures in the economic, psychosocial, physiological, and perinatal ecologies of children, in association with brain structure and cognitive performance in a diverse sample of 8,158 9-10-year-old children from the Adolescent Brain Cognitive Development (ABCD) study. SES was measured by the income-to-needs ratio (INR), a measure used by federal poverty guidelines. Within the ABCD study, in what is one of the largest and most diverse cohorts of children studied in the United States, we replicate associations of low SES with lower total cortical surface area and worse cognitive performance. Associations between low SES (<200% INR) and measures of development showed the steepest increases with INR, with apparent increases still visible beyond the level of economic disadvantage in the range of 200-400% INR. Notably, we found three latent factors encompassing positive ecologies for children across the areas of economic, psychosocial, physiological, and perinatal well-being in association with better cognitive performance and the higher total cortical surface area beyond the effects of SES. Specifically, latent factors encompassing youth perceived social support and perinatal well-being were positive predictors of developmental measures for all children, regardless of SES. Further, we found a general latent factor that explained relationships between 20 of the proximal measures and encompassed a joint ecology of higher social and economic resources relative to low adversity across psychosocial, physiological, and perinatal domains. The association between the resource-to-adversity latent factor and cognitive performance was moderated by SES, such that for children in higher SES households, cognitive performance progressively increased with these latent factor scores, while for lower SES, cognitive performance increased only among children with the highest latent factor scores. Our findings suggest that both positive ecologies of increased access to resources and lower adversity are mutually critical for promoting better cognitive development in children from low SES households. Our findings inform future studies aiming to examine positive factors that influence healthier development in children.
                      Cover page: Positive Economic, Psychosocial, and Physiological Ecologies Predict Brain Structure and Cognitive Performance in 9–10-Year-Old Children
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