To the Editor: Dr Costello and colleagues1 reported that children had fewer symptoms of conduct and oppositional defiant disorders ("behavioral symptoms") after an income intervention that moved their families out of poverty, but that anxiety and depression symptoms ("emotional symptoms") were unaffected. After leaving poverty, however, ex-poor children were significantly less likely to have emotional symptoms than while in poverty, and were then no more likely to report emotional symptoms than were children who were never poor. Furthermore, ex-poor children were less likely to have an emotional symptom after leaving poverty than were persistently poor children, but this difference achieved borderline significance (P = .05) and was reported as a negative result.
Given these findings, more direct statistical evaluation would have aided the authors' assessment of "whether the effect of moving out of poverty applied equally to emotional and behavioral symptoms." For example, the difference between ex-poor and never poor children in the odds of having a behavioral symptom after intervention could have been compared with the difference between those groups in the odds of having an emotional symptom.
Thus, the authors may have been overly cautious in their conclusion that their results "support a social causation explanation for conduct and oppositional disorder, but not for anxiety or depression." Indeed, accelerating the reduction of poverty in the final year of the authors' study suggests that continued follow-up might have expanded the ex-poor cohort and enhanced power to detect effects on emotional symptoms.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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