title: Testing proximal and distal protective processes in preterm high-risk children.
abstract: The purpose was to examine a model that incorporates cumulative medical risk at age 4 and distal and protective processes at age 8 to assess school-age competency outcomes of cognition, school achievement, and socioemotional well-being in a sample of preterm children born at various degrees of medical risk. Cumulative medical risk and distal protective and proximal maternal protective processes were constructed into indexes. Hierarchical multiple regression analysis were performed entering the cumulative medical risk index first, followed by distal and proximal protective processes in the next two steps to test the effect on cognitive, academic, and socioemotional competence. For participants, 151 preterm and 39 full-term infants were recruited at birth into a prospective longitudinal study and followed until age 8 with a 97% retention rate. Children were stratified by birth weight and socioeconomic status. The hypotheses were supported. Significant main effects for cumulative medical risk and distal and proximal protective processes in all competency outcome models are key findings. The addition of protective processes was small to moderate in effect (6%-18%) yet clinically significant. These findings illustrate the advantage of applying cumulative medical risk and protection approach to better understand school-age outcomes. Multiple risk and protective models emphasize the joint occurrence of individual contextual processes in the understanding of competence outcomes in high-risk children.
authors.affiliation: University of Rhode Island, College of Nursing, Kingston, Rhode Island, USA. risc@etal.uri.edu
authors.forename: Margaret M
authors.initials: MM
authors.lastname: McGrath
authors.forename: Mary
authors.initials: M
authors.lastname: Sullivan
mesh_terms: D001034:Apgar Score; D001077:Aptitude Tests; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008425:Maternal Behavior; D009511:New England; D012107:Research Design; D012307:Risk Factors; D012959:Socioeconomic Factors